35Identification numbers—allocation rules

35 Identification numbers—allocation rules

Who is covered by this section? (1) A person is covered by this section if: (a) the person is any of the following (within the meaning of the Health Insurance Act): (i) a practitioner; (ii) an approved pathology practitioner; (iii) a participating midwife; (iv) a participating nurse practitioner; (v) an optometrist; or (b) the person provides, or intends to provide, a health service determined under subsection 3C(1) of the Health Insurance Act. Allocation—mandatory rule (2) Subject to subsections (6) to (8), if: (a) a person is covered by this section; and (b) the person applies to the Chief Executive Medicare for an identification number to be allocated to the person for a place of practice; and (c) if the application is made using the HPOS system: (i) the application is a compliant online application; and (ii) the application does not require additional verification (see subsection (3)); and (d) if the application is not made using the HPOS system: (i) the application is a compliant manual application; and (ii) if the Chief Executive Medicare has requested, in writing, that the person give the Chief Executive Medicare specified additional information or documents in connection with the application—the person has complied with the request; then the Chief Executive Medicare must allocate an identification number to the person for the place of practice, with effect from the default start day in relation to the person’s application (see subsection (4)).

Note: For HPOS system, see section 5. For compliant online application and compliant manual application, see section 35A.

(3) For the purposes of subparagraph (2)(c)(ii), an application made using the HPOS system requires additional verification if: (a) the HPOS system requires one or more documents to accompany the application; or (b) the Chief Executive Medicare has requested, in writing, that the person give the Chief Executive Medicare specified additional information or documents in connection with the application. (4) For the purposes of this section, the default start day in relation to an application for an identification number to be allocated to a person for a place of practice is the following: (a) for an application that is made using the HPOS system: (i) if the application specifies a day on which the allocation should take effect, and that day is after the day on which the application is made—the day specified in the application; or (ii) otherwise—the day on which the application is made; (b) for an application that is not made using the HPOS system: (i) if the application specifies a day on which the allocation should take effect (whether that day is the day on which the application is made or an earlier or later day)—the day specified in the application; or (ii) otherwise—the day on which the application is made. Allocation—discretions (5) If: (a) the conditions in paragraphs (2)(a) and (b) are met; and (b) the conditions in paragraph (2)(c) or (d) (whichever applies) are not met; then the Chief Executive Medicare may, if the Chief Executive Medicare is satisfied (having regard to the allocation considerations) that it would be appropriate to do so, allocate an identification number to the person for the place of practice, with effect from the default start day in relation to the person’s application. (6) If: (a) the conditions in paragraphs (2)(a) to (d) (to the extent that they apply) are all met; and (b) the person is ineligible for benefits at the place of practice on the default start day in relation to the person’s application; then the Chief Executive Medicare may refuse to allocate an identification number to the person for the place of practice. (7) If: (a) the conditions in paragraphs (2)(a) and (b) are met (whether or not the conditions in paragraph (2)(c) or (d) (whichever applies) are met); and (b) the person is ineligible for benefits at the place of practice on the default start day in relation to the person’s application; and (c) there is an identifiable day (being a day after the default start day) on which the person will no longer be ineligible for benefits at the place of practice; then the Chief Executive Medicare may allocate an identification number to the person for the place of practice with effect from the earliest such identifiable day. (8) If: (a) the conditions in paragraphs (2)(a) to (d) (to the extent that they apply) are all met; and (b) either: (i) the person has not provided a street address for the place of practice; or (ii) information included in, or documents accompanying, the person’s application, or information or documents given by the person to the Chief Executive Medicare in connection with that application, are false or misleading in a material respect; then the Chief Executive Medicare may refuse to allocate an identification number to the person for the place of practice. (9) To avoid doubt: (a) subsections (5) to (8) do not impose any obligation on the Chief Executive Medicare to consider whether to exercise any of the discretions of the Chief Executive Medicare under those subsections; and (b) if the Chief Executive Medicare does not consider whether to exercise the discretion of the Chief Executive Medicare under one of those subsections, then that subsection does not apply in relation to the person and the place of practice.