11When may the Chief Executive Medicare certify a claim as a qualifying claim?

11 When may the Chief Executive Medicare certify a claim as a qualifying claim?

Criteria for certification—Level 1 (1) The Chief Executive Medicare may issue a certificate stating that a claim is a Level 1 qualifying claim if the Chief Executive Medicare is satisfied that: (a) the claim meets the common requirements set out in subsection (3); and (b) a person has applied for a Level 1 qualifying claim certificate in relation to the claim in accordance with section 12. Criteria for certification—Level 2 (2) The Chief Executive Medicare may issue a certificate stating that a claim is a Level 2 qualifying claim if the Chief Executive Medicare is satisfied that: (a) the claim meets the common requirements set out in subsection (3); and (b) the claim meets the additional Level 2 requirements set out in subsection (4); and (c) a person has applied for a Level 2 qualifying claim certificate in relation to the claim in accordance with section 12. Common requirements for both Level 1 and Level 2 qualifying claim certificates (3) A claim in relation to which an application for a Level 1 or Level 2 qualifying claim certificate has been made meets the common requirements set out in this subsection if: (a) for a claim that relates to an incident that is not a Birthing on Country out‑of‑hospital incident—the claim is or was made against a person (the midwife); or (aa) for a claim that relates to a Birthing on Country out‑of‑hospital incident—the claim is or was made against: (i) a person (also the midwife); or (ii) the eligible entity for a person (also the midwife); and

Note 1: A claim may be made against a midwife and the eligible entity that employed or engaged the midwife in relation to the same incident.

Note 2: A claim may be made against a midwife in relation to an incident that occurs or occurred in the course of the midwife attending a homebirth under a Birthing on Country model.

(b) the claim relates to an incident that occurs or occurred in the course of, or in connection with, the midwife’s practice as an eligible midwife; and
(c) there is a contract of insurance entered into by an eligible insurer that provides midwife professional indemnity cover in relation to the claim; and
(d) except in the circumstances specified in Rules made for the purposes of this paragraph, the incident occurs or occurred in Australia or an external Territory; and
(e) if the claim relates to an incident that is not an out‑of‑hospital incident—the claim does not relate to an incident that occurs or occurred in the course of, or in connection with, the provision of treatment of a public patient of a hospital; and
(f) the claim does not relate to an incident that occurs or occurred in the course of, or in connection with, practice of a kind for which:
(i) the Commonwealth, a State or a Territory; or
(ii) a local governing body; or
(iii) an authority established under a law of the Commonwealth, a State or a Territory;
indemnifies eligible midwives from liability relating to compensation; and
(h) if the application is for a Level 1 qualifying claim certificate for a claim that relates to an incident that is not an out‑of‑hospital incident, the incident occurs or occurred:
(i) on or after 1 July 2010; and
(ii) on or before the Level 1 termination date (if any); and
(ha) if the application is for a Level 1 qualifying certificate for a claim that relates to an out‑of‑hospital incident, the incident occurs or occurred:
(i) on or after 1 July 2025; and
(ii) on or before the Level 1 termination date for claims in relation to out‑of‑hospital incidents (if any); and
(i) if the application is for a Level 2 qualifying claim certificate for a claim that relates to an incident that is not an out‑of‑hospital incident, the incident occurs or occurred:
(i) on or after 1 July 2010; and
(ii) on or before the Level 2 termination date (if any); and
(ia) if the application is for a Level 2 qualifying certificate for a claim that relates to an out‑of‑hospital incident, the incident occurs or occurred:
(i) on or after 1 July 2025; and
(ii) on or before the Level 2 termination date for claims in relation to out‑of‑hospital incidents (if any); and
(j) the claim is not in substance an aggregation of:
(i) two or more separate claims against the midwife; or
(ii) for a claim made against the eligible entity—two or more separate claims against the entity in relation to the midwife; and
(k) the claim is not a claim included in a class specified in Rules made for the purposes of this paragraph; and
(l) the claim does not relate to an incident of a kind specified in Rules made for the purposes of this paragraph; and
(m) the claim does not relate to a type of midwifery practice specified in Rules made for the purposes of this paragraph.