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Commonwealth legislation
This Act has been repealed and is no longer in force. It is retained for historical reference.
The Regulations establish the Medical Expenses Scheme, Australia’s first national medical insurance: doctors may opt in as “participating” practitioners and, when they treat patients, the Commonwealth pays up to half a government‑set “prescribed fee” directly to the doctor, reducing patients’ bills. An extensive fee schedule sets rates (varying by time, complexity and travel). The scheme requires detailed record‑keeping, allows patient opt‑out, adjusts subsidies for compensation recoveries, and empowers the Director‑General to discipline non‑compliant doctors.
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Direct links to the current provisions in National Health (Medical Expenses) Regulations.
Sourced from the Federal Register of Legislation (legislation.gov.au), CC BY 4.0.
STATUTORY RULES.
1949. No. 92.
REGULATIONS UNDER THE NATIONAL HEALTH SERVICE
ACT 1948-1949.*
I, THE GOVERNOR-GENERAL in and over the Commonwealth of Australia, acting with the advice of the Federal Executive Council, hereby make the following Regulations under the National Health Service Act 1948-1949.
Dated this twenty-third day of November, 1949.
W. J. McKELL
Governor-General.
By His Excellency's Command,
N. E. McKENNA
Minister of State for Health.
National Health (Medical Expenses) Regulations.
Citation.
Definition.
Establishment of Scheme.
Application of Scheme.
4.—(1.) The Minister may, by notice published in the Gazette, declare that the Scheme shall not apply in relation to professional services rendered on or after a date specified in the notice—
(a) in a part of Australia specified in the notice, being a part of Australia in which the Commonwealth provides, or will, after that date, provide, otherwise than under the Scheme, benefits or services which, in the opinion of the Minister, render the application of the Scheme unnecessary in that part of Australia ; or
(b) by a medical practitioner in accordance with the terms of an agreement between the medical practitioner and the Commonwealth, a State or any other body or person.
(2.) On and after the date specified in a notice under this regulation, and until the notice is revoked, the Scheme shall not apply in relation to the services to which the notice relates.
* Notified in the Commonwealth Gazette on 25th November, 1949.
5224.—Price 8d.
Jurisdiction to hear appeals against suspension.
5.—(1.) The Supreme Court of each State is hereby invested with federal jurisdiction, and jurisdiction is hereby conferred on the Supreme Court of each Territory of the Commonwealth, to hear and determine appeals under clause 13 of the Scheme.
(2.) The Director-General shall be the respondent in any such appeal.
(3.) Upon the hearing of any such appeal, the Supreme Court may—
(a) admit further evidence, either orally or upon affidavit or otherwise ;
(b) permit the examination and cross-examination of witnesses ;
(c) affirm, reverse or modify the decision of the Director-General ; and
(d) order any party to pay costs to any other party.
(4.) If the Supreme Court is satisfied that there has been undue delay by the medical practitioner in prosecuting his appeal, the Court may dismiss the appeal without hearing it.
Scheme to have effect.
6.—(1.) The provisions of the Scheme shall, by force of these Regulations, have effect according to their tenor.
(2.) The provisions of the Acts Interpretation Act 1901-1948 shall apply as if the clauses of the Scheme were regulations contained in these Regulations.
THE SCHEDULE. Reg. 3.
MEDICAL EXPENSES SCHEME
Citation.
1. This Scheme may be cited as the Medical Expenses Scheme.
Interpretation.
2.—(1.) In this Scheme, unless the contrary intention appears-
" medical practitioner " means a person registered or licensed as a medical practitioner under a law of a State or of the Australian Capital Territory providing for the registration or licensing of medical practitioners ;
" participating medical practitioner " means a medical practitioner whose name is recorded in the list of participating medical practitioners maintained in accordance with this Scheme ;
" professional service " means a service rendered by a participating medical practitioner in his capacity as a medical practitioner, being a service to which this Scheme applies, and includes any travelling incidental to the performance of any such service, but does not include the supply of materials or appliances;
" the Act "' means the National Health Service Act 1948-1949 ;
" the Minister " means the Minister of State for Health ;
" the prescribed fee ", in respect of a professional service, means the fee in respect of that service ascertained in accordance with clause 16 of this Scheme.
(2.) For the purposes of this Scheme, two or more professional services rendered by a medical practitioner in respect of one person on the same occasion shall be deemed to be one professional service.
(3.) For the purposes of this Scheme, a participating medical practitioner shall be deemed to render a service where the service is rendered by another medical practitioner in circumstances in which the fee for the service is payable directly to that participating medical practitioner.
(4.) In this Scheme any reference to a form shall be read as a reference to a form in the Appendix of Forms annexed to this Scheme.
Delegation.
3.—(1.) The Director-General may, in relation to any particular matter or class of matters, or to any particular part of the Commonwealth, by writing under his hand, delegate to any person all or any of his powers or functions under this Scheme (except this power of delegation) so that the delegated powers or functions may be exercised by the delegate with respect to the matter or class of matters, or the part of the Commonwealth, specified in the instrument of delegation as fully and effectually as by the Director-General.
(2.) Every delegation under this clause shall be revocable at will and no delegation shall prevent the exercise of any power or function by the Director-General.
Services to which Scheme applies.
4. Except as otherwise provided in this Scheme or in the Act or in regulations made under the Act, this Scheme shall apply to every service rendered by a participating medical practitioner, in his capacity as a medical practitioner, for which the medical practitioner is entitled to charge a fee.
Payments by Commonwealth.
5. Where a participating medical practitioner renders a professional service, the Commonwealth shall, subject to this Scheme, be liable to pay to the medical practitioner, on behalf of the person liable to pay the fee for that service, so much of that fee as does not exceed one-half of the prescribed fee, and the person so liable shall, to the extent of the liability of the Commonwealth under this clause, be discharged from his liability.
Friendly societies, &c.
6. Where—
(a) a participating medical practitioner renders professional services for which he does not charge specific fees but for which he is) remunerated under arrangements between himself and a society or body which, or person who, conducts a scheme of medical benefits; and
(b) the Director-General declares, by notice published in the Gazette or given to the medical practitioner, that he is satisfied that the arrangements between the medical practitioner and that society, body or person are such that while this Scheme applies in relation to those services, the persons entitled to the benefits of the scheme so conducted will directly or indirectly receive the benefit of payments made under this Scheme in respect of those services,
this Scheme shall, on and after a date specified in the notice and while the notice is unrevoked, apply in respect of those services as if there were payable to the medical practitioner for each such service a fee equal to the prescribed fee.
Cases where workers' compensation or damages payable
7.—(1.) Where a person has received, or is entitled to receive or to have made for his benefit, in respect of the expenses of a professional service, a payment (in this clause referred to as “ the indemnity ")—
(a) by way of compensation or damages (including settlement of a claim for damages) ; or
(b) otherwise under any law, but not including a payment resulting wholly or partly from contributions made by that person,
the amount payable by the Commonwealth under this Scheme in respect of that service shall be reduced by the amount by which the indemnity exceeds half the prescribed fee.
(2.) Where, in respect of an injury for which a person has received or receives a professional service, there is or has been awarded or paid, or agreed to be paid, an amount by way of damages or in settlement of a claim for damages, so much of that amount as does not exceed the prescribed fee shall, for the purposes of this clause, be deemed to be awarded, paid or agreed to be paid (as the case may be) in respect of the injured person's expenses of that professional service.
(3.) Where a participating medical practitioner is not aware that sub-clause (1.) of this clause is applicable in relation to a professional service rendered, by him, or is in doubt as to whether, or to what extent, that sub-clause is so applicable, he shall be entitled to claim and receive payment from the Commonwealth under this Scheme as if that sub-clause did not apply.
(4.) Where the Commonwealth has made a payment to a medical practitioner in respect of a professional service in relation to which sub-clause (1.) of this clause is applicable—
(a) the medical practitioner shall be liable to repay that amount to the Commonwealth to the extent of so much of any amount of the indemnity paid directly to him as exceeds the balance of the fee charged by him remaining after deducting the payment made by the Commonwealth; and
(b) the person on whose behalf the Commonwealth made the payment shall be liable to pay to the Commonwealth so much of any amount of the indemnity received or receivable by him as exceeds so much of the fee charged by the medical practitioner as is in excess of half the prescribed fee and does not exceed the payment made by the Commonwealth.
(5.) Where a person or authority who or which is liable or proposes to pay the indemnity or part thereof is aware that the professional service to which the payment relates was, or is likely to be, rendered by a participating medical practitioner, that person or authority shall, before making the payment, inform the Director-General in writing of the facts relating to the proposed payment, and shall not make the payment before the expiration of fourteen days after he or it has so informed the Director-General.
(6.) Where—
(a) the Commonwealth has made a payment to a medical practitioner in respect of a professional service to which sub-clause (1.) of this clause is applicable ; and
(b) a person or authority is liable to make a payment referred to in sub-clause (1.) of this clause in relation to the expenses of that professional service,
the Director-General may serve on that person or authority, by post or otherwise, a notice requiring that person or authority to pay to the Director-General an amount specified in the notice, being an amount
not exceeding the amount which that person or authority is so liable to pay or the amount which the person liable to pay the fee for the professional service would, under this clause, be liable to pay to the Commonwealth if the 'payment were made to him (whichever is the less).
(7.) Where a notice is served on a person or authority in accordance with the last preceding sub-clause—
(a) that person or authority shall be liable to pay to the Commonwealth the amount specified in the notice ; and
(b) payment of any amount to the Commonwealth in pursuance of the notice shall, to the extent of that payment, and not-withstanding any defect in the notice, be a good discharge of the obligation of that person or authority to make the payment referred to in sub-clause (1.) of this clause.
Medical practitioners entitled to become participating medical practitioners.
8.—(1.) Subject to the next succeeding sub-clause, every medical practitioner shall be entitled to become a participating medical practitioners.
(2.) A medical practitioner who has been suspended from participation in the Scheme shall not, during the period of his suspension, be entitled to become a participating medical practitioner.
Notice of desire to participate.
9. A medical practitioner who desires to participate in the Scheme shall forward a notice in writing to that effect to the Director-General and shall specify in the notice the address or addresses of the premises at which he conducts or will conduct his practice.
List of participating medical practitioners.
10.—(1.) Upon receipt of a notice in accordance with the last preceding clause, the Director-General shall cause the name of the medical practitioner to be recorded in a list of participating medical practitioners maintained for that purpose.
(2.) The Director-General shall forthwith notify the medical practitioner in writing of the date on which the medical practitioner became a participating medical practitioner.
Termination of participation.
11.—(1.) The Director-General shall, at the request of a participating medical practitioner, forthwith remove the name of the medical practitioner from the list of participating medical practitioners and the medical practitioner shall thereupon cease to be a participating medical practitioner.
(2.) The Director-General shall forthwith notify the medical practitioner in writing of the date on which he ceased to be a participating medical practitioner.
(3.) The fact that a participating medical practitioner has ceased to be a participating medical practitioner shall not affect his rights, obligations and liabilities arising out of or in connexion with professional services rendered by him while he was a participating medical practitioner, and, for the purposes of those rights, obligations and liabilities, he shall be deemed to be a participating medical practitioner.
(4.) Without prejudice to the right of a participating medical practitioner to withdraw at any time from participation in this Scheme, the operation of this Scheme in relation to participating medical practitioners shall be subject to amendments made from time to time to this Scheme, or to the regulations by which this Scheme is established.
Suspension of participating medical practitioners.
12.—(1.) Where a participating medical practitioner—
(a) repeatedly fails to comply with the provisions of this Scheme ; or
(b) defrauds or attempts to defraud the Commonwealth in connexion with the operation of this Scheme,
the Director-General may suspend the medical practitioner from participation in the Scheme for a period not exceeding six months.
(2.) The Director-General may at any time remove any such suspension subject to such conditions (if any) as the Director-General thinks fit to impose.
(3.) Before deciding to suspend a participating medical practitioner under this clause, the Director-General shall—
(a) serve on the participating medical practitioner a notice specifying the grounds on which his suspension is being considered ;
(b) refer the matter to a committee established in pursuance of section 16 of the Act for inquiry and report to the Director-General ; and
(c) take into consideration the report of the committee.
(4.) An inquiry under this clause shall be conducted by the committee in such manner as the Director-General directs.
(5.) The participating medical practitioner shall be entitled to attend the inquiry and be heard by the committee.
(6.) Where the Director-General, after an inquiry by a committee, decides to suspend the participating medical practitioner from participation in this Scheme, the Director-General shall serve notice of the proposed suspension on the medical practitioner.
Appeals.
13. The medical practitioner may, within fourteen days after service of the notice under the last preceding sub-clause, appeal against the proposed suspension to the Supreme Cour
This is an opening excerpt, not the complete document.