47. Review of decisions

(1) In this section, reviewable decision means:

(a) a determination of the Chief Executive Medicare under section 34; or

(b) a deemed decision under subsection 27 (2) or 36 (2); or

(c) a determination of a responsible officer under Part 8.

(2) A medical practitioner (the applicant) affected by a reviewable decision referred to in paragraphs (1) (a) or (b) may seek review of the decision (the original decision) by a Departmental employee (within the meaning of the Human Services (Medicare) Act 1973) authorised by the Chief Executive Medicare (the reviewing officer).

(3) A contractor (the applicant) affected by a reviewable decision referred to in paragraphs (1) (a) or (c) may seek review of the decision (the original decision):

(a) for a decision referred to in paragraph (1) (a), by a Departmental employee (within the meaning of the Human Services (Medicare) Act 1973) authorised by the Chief Executive Medicare (the reviewing officer); or

(b) for a decision referred to in paragraph (1)(a) made by the Chief Executive Medicare or a decision referred to in paragraph 1(c) made by a person mentioned in paragraph (a) of the definition of responsible officer, a person mentioned in paragraph (b) of that definition (the reviewing officer); or

(c) for a decision referred to in paragraph (1)(c) made by a person mentioned in paragraph (b) of the definition of responsible officer, a Deputy Secretary of the Department (the reviewing officer).

(4) A Departmental employee (within the meaning of the Human Services (Medicare) Act 1973) must not be authorised as a reviewing officer unless the employee has a classification higher than the classification of the official who made the original decision.

(5) The reviewing officer must:

(a) confirm the original decision; or

(b) substitute the original decision with another decision.

(6) The reviewing officer must give to the applicant:

(a) a notice in writing stating the outcome of the review; and

(b) the reasons for the decision.

(7) The applicant may apply to the Administrative Appeals Tribunal for review of the reviewing officer’s decision.

Note Under section 27A of the Administrative Appeals Tribunal Act 1975, the decision-maker must give to any person whose interests are affected by the decision notice, in writing or otherwise, of the making of the decision and of the person’s right to have the decision reviewed.

(8) Where a medical practitioner applies for review of a reviewable decision under subsections (2) or (7), the amount of the premium is not reviewable.

Note The PSS contract is to provide for dispute-resolution processes (see section 8 of this Scheme).