the day on which the allocation of a provider number takes effect (including changing this day);

revoking the allocation of a provider number;

suspending the allocation of a provider number, changing the day on which the suspension takes effect and lifting the suspension;

reconsideration and review of decisions.

a practitioner;

an approved pathology practitioner;

a participating midwife;

a participating nurse practitioner;

an optometrist;

a health professional of a kind specified in an instrument under subsection (7).

be given electronically in accordance with the Health Professional Online Services system maintained by Services Australia or another electronic system approved by the Chief Executive Medicare under subsection (8); and

include the information required by that system to be included in the application; and

be accompanied by any documents required by that system to accompany the application.

be in the appropriate form approved by the Chief Executive Medicare under paragraph (9)(a); and

include the information required by the form; and

be accompanied by any documents required by the form; and

be made in the manner (if any) approved by the Chief Executive Medicare under paragraph (9)(b).

the application is in the appropriate form approved as mentioned in paragraph (5)(a); and

the application is uploaded to the Health Professional Online Services system maintained by Services Australia or another electronic system approved as mentioned in paragraph (4)(a).

approve one or more forms for the purposes of paragraph (5)(a);

approve a manner for the purposes of paragraph (5)(d).

the application complies with subsection 22D(4); and

the criteria (if any) specified in an instrument under subsection (6) of this section are met in connection with the application.

allocate a unique provider number to the applicant for a particular place of practice if the Chief Executive Medicare is satisfied that it would be appropriate in all the circumstances to do so; or

otherwise, refuse to allocate a provider number to the applicant for a particular place of practice.

the period specified in the notice (which must be at least 14 days after the day the notice is given), unless paragraph (b) applies;

if the Chief Executive Medicare allows a longer period—that longer period.

numbers;

letters;

symbols.

kinds of applicants under section 22D;

kinds of places of practice that are the subject of applications under that section;

kinds of professional services (if any) that are, or are to be, rendered by, or on behalf of, those applicants at those places of practice.

the decision;

the provider number and the place of practice;

the day on which the allocation of the provider number takes effect, which must be:

the day of the decision, unless subparagraph (ii) applies; or

if the applicant, in the application, specified a day on which any allocation of a provider number for that place of practice should take effect and that day is after the day of the decision—that specified day.

the decision;

for a decision covered by paragraph 22E(2)(a):

the provider number and the place of practice; and

the day on which the allocation of the provider number takes effect, which may be the day of the decision, an earlier day or a later day;

for a refusal decision covered by paragraph 22E(2)(b)—the reasons for the decision.

the applicant under section 22D has not been notified, under subsection (2) of this section, of the original decision; and

the Chief Executive Medicare is satisfied that the original decision is not correct.

the Chief Executive Medicare must make a new decision under subsection 22E(2) in substitution for the original decision; and

the Chief Executive Medicare is not required, under subsection (2) of this section, to notify the applicant under section 22D of the original decision.

change the day of effect of the allocation of the provider number to another specified day; or

refuse to change the day of effect of the allocation of the provider number.

the decision;

for a decision under paragraph (3)(a)—the new day of effect of the allocation of the provider number, which must be a day before the current day;

for a refusal decision under paragraph (3)(b)—the reasons for the decision.

the person has not been notified, under subsection (4), of the original decision; and

the Chief Executive Medicare is satisfied that the original decision is not correct.

the Chief Executive Medicare must make a new decision under subsection (3) in substitution for the original decision; and

the Chief Executive Medicare is not required, under subsection (4), to notify the person of the original decision.

the decision;

the reasons for the decision;

the day that the revocation takes effect, which must not be earlier than the day after the notification is given to the person.

the person has not been notified, under subsection (4), of the original decision; and

the Chief Executive Medicare is satisfied that the original decision is not correct.

the holder of the provider number:

requests, in writing, the Chief Executive Medicare to suspend the allocation of the provider number; and

specifies in the request the day on which the suspension is to take effect, being a day on or after the day the request is made; or

the applicant under section 22D for the allocation of the provider number:

requested, in the application, the Chief Executive Medicare to also suspend the allocation of the provider number; and

specified in the application the day on which the suspension is to take effect, being a day on or after the day the application is made.

the decision;

the day on which the suspension takes effect, which must be the day covered by subparagraph (1)(a)(ii) or (b)(ii).

the decision;

the reasons for the decision;

the day on which the suspension takes effect, which must not be earlier than the day after the notification is given to the person allocated the provider number.

the person allocated the provider number has not been notified, under subsection (5), of the original decision; and

the Chief Executive Medicare is satisfied that the original decision is not correct.

be given electronically in accordance with the Health Professional Online Services system maintained by Services Australia or another electronic system approved by the Chief Executive Medicare under subsection (6); and

not specify a new day for the suspension to take effect that is a day before the day of the application; and

include the information required by that system to be included in the application; and

be accompanied by any documents required by that system to accompany the application.

be in the appropriate form approved by the Chief Executive Medicare under paragraph (7)(a); and

not specify a new day for the suspension to take effect that is a day before the day of the application; and

include the information required by the form; and

be accompanied by any documents required by the form; and

be made in the manner (if any) approved by the Chief Executive Medicare under paragraph (7)(b).

the application is in the appropriate form approved as mentioned in paragraph (4)(a); and

the application is uploaded to the Health Professional Online Services system maintained by Services Australia or another electronic system approved as mentioned in paragraph (3)(a).

approve one or more forms for the purposes of paragraph (4)(a);

approve a manner for the purposes of paragraph (4)(e).

the application complies with subsection 22M(3); and

the criteria (if any) specified in an instrument under subsection (8) of this section are met in connection with the application.

change the day on which the suspension takes effect to a specified day if the Chief Executive Medicare is satisfied that it would be appropriate in all the circumstances to do so; or

otherwise, refuse to change the day on which the suspension takes effect.

the period specified in the notice (which must be at least 14 days after the day the notice is given), unless paragraph (b) applies;

if the Chief Executive Medicare allows a longer period—that longer period.

the decision;

the new day on which the suspension takes effect, which must be the day specified by the holder in the application.

the decision;

for a decision covered by paragraph (2)(a) or subsection (5)—the new day on which the suspension takes effect, which must not be a day before the day of the decision;

for a refusal decision covered by paragraph (2)(b)—the reasons for the decision.

the holder has not been notified, under subsection (7), of the original decision; and

the Chief Executive Medicare is satisfied that the original decision is not correct.

the Chief Executive Medicare must make a new decision under subsection (2) in substitution for the original decision; and

the Chief Executive Medicare is not required, under subsection (7), to notify the holder of the original decision.

be given electronically in accordance with the Health Professional Online Services system maintained by Services Australia or another electronic system approved by the Chief Executive Medicare under subsection (6); and

include the information required by that system to be included in the application; and

be accompanied by any documents required by that system to accompany the application.

be in the appropriate form approved by the Chief Executive Medicare under paragraph (7)(a); and

include the information required by the form; and

be accompanied by any documents required by the form; and

be made in the manner (if any) approved by the Chief Executive Medicare under paragraph (7)(b).

the application is in the appropriate form approved as mentioned in paragraph (4)(a); and

the application is uploaded to the Health Professional Online Services system maintained by Services Australia or another electronic system approved as mentioned in paragraph (3)(a).

approve one or more forms for the purposes of paragraph (4)(a);

approve a manner for the purposes of paragraph (4)(d).

the application complies with subsection 22P(3); and

the criteria (if any) specified in an instrument under subsection (7) of this section are met in connection with the application.

lift the suspension on a specified day if the Chief Executive Medicare is satisfied that it would be appropriate in all the circumstances to do so; or

otherwise, refuse to lift the suspension.

the period specified in the notice (which must be at least 14 days after the day the notice is given), unless paragraph (b) applies;

if the Chief Executive Medicare allows a longer period—that longer period.

the decision;

the day on which the suspension is lifted, which must be:

the day of the decision, unless subparagraph (ii) applies; or

if the holder, in the application, specified a day on which any lifting of the suspension should take effect and that day is after the day of the decision—that specified day.

the decision;

for a decision to lift the suspension—the day on which the suspension is lifted, which may be the day of the decision, an earlier day or a later day;

for a refusal decision—the reasons for the decision.

the holder has not been notified, under subsection (6), of the original decision; and

the Chief Executive Medicare is satisfied that the original decision is not correct.

the Chief Executive Medicare must make a new decision under subsection (2) in substitution for the original decision; and

the Chief Executive Medicare is not required, under subsection (6), to notify the holder of the original decision.

making, or refusing or failing to make, a decision under subsection 22E(1), 22K(1), 22N(1) or 22Q(1); or

doing, or refusing or failing to do, anything related to making a decision covered by paragraph (a).

if the Chief Executive Medicare specifies the day on which the substituted action takes effect—that specified day; or

otherwise—the day of the administrative action taken by the operation of the computer program.

the decision; and

the fact that the decision was made by the operation of a computer program.

of the substituted decision and of the fact that the substituted decision was made by the Chief Executive Medicare; and

of the person’s right to make an application under section 22T for reconsideration of the substituted decision.

to the effect that the Chief Executive Medicare has made such an arrangement; and

setting out those particular provisions.

the total number of substituted actions taken by the Chief Executive Medicare under subsection 22R(4) in that period;

the kind of substituted actions so taken;

the kind of administrative action taken by the operation of the computer program that the Chief Executive Medicare was satisfied was not correct.

a decision under paragraph 22E(2)(b) to refuse to allocate a provider number for a place of practice;

a decision under paragraph 22G(3)(a) to change the day of effect of the allocation of a provider number to a day that is different from the day nominated by the person allocated the provider number;

a decision under paragraph 22G(3)(b) to refuse to change the day of effect of the allocation of a provider number;

a decision under subsection 22J(1) or (3) to revoke the allocation of a provider number for a place of practice (except if that place of practice was not one covered by the person’s application under section 22D);

a decision under subsection 22K(2) or (3) to suspend the allocation of a provider number;

a decision under paragraph 22N(2)(b) to refuse to change the day on which the suspension of the allocation of a provider number takes effect;

a decision under subsection 22N(5) to change the day on which the suspension of the allocation of a provider number takes effect;

a decision under paragraph 22Q(2)(b) to refuse to lift the suspension of the allocation of a provider number;

a decision under subsection 22R(4) in substitution for a decision the Chief Executive Medicare is treated as having taken under subsection 22R(3).

before the end of the period of 30 days beginning on the day on which the Chief Executive Medicare notifies the person of the decision, unless paragraph (b) applies;

if the Chief Executive Medicare allows a longer period for making the request—before the end of that longer period.

the person makes another application under section 22D for the allocation of a provider number to the person for that place of practice; and

the person makes the other application before the Chief Executive Medicare makes a decision under subsection (5) of this section on reconsideration of the decision made under paragraph 22E(2)(b).

must affirm, vary or set aside the decision covered by subsection (1); and

if the Chief Executive Medicare sets aside the decision—may make such other decision as the Chief Executive Medicare thinks appropriate.

the period of 60 days beginning on the day the Chief Executive Medicare receives the request, unless paragraph (b) applies;

if the person and the Chief Executive Medicare agree on a longer period—that longer period.

on the day specified in the notice; or

if a day is not specified in the notice—on the day on which that decision is made.

the Chief Executive Medicare makes a decision under this Part on a day; and

the effect of the decision is that:

(i) the allocation of a provider number to a person (the relevant person) for a place of practice comes into effect, or resumes being in effect, on or before that day; or

(ii) the suspension of the allocation of a provider number to a person (the relevant person) for a place of practice takes effect on or before that day;

that, before the commencement of this item:

(i) for the purposes of the Health Insurance Act 1973, was allocated, or taken to have been allocated, under the Human Services (Medicare) Regulations 2017 to a person in relation to a place of practice; or

(ii) for the purposes of the Health Insurance Act 1973, was allocated, as mentioned in paragraph 18(b) of the former Medicare Australia (Functions of Chief Executive Officer) Direction 2005, to a person in respect of a place of practice; or

(iii) for the purposes of the Health Insurance Act 1973, was allocated under the former Health Insurance Commission Regulations, or former Health Insurance Commission Regulations 1975, to a person in respect of a place of practice; and

that was in effect immediately before the commencement of this item;

(a) before the commencement of this item, a person covered by Human Services (Medicare) Regulations 2017 had made a request to the Chief Executive Medicare for the allocation of an identification number in relation to a place of practice; andsection 35 of the

the Chief Executive Medicare had not decided the request before that commencement;

(c) were a documentary application made under Health Insurance Act 1973 for the allocation of a provider number to the person for the place of practice; andsection 22D of the

complied with subsection 22D(5) of that Act.

before the commencement of this item:

(i) an identification number was allocated, or purportedly allocated, under Human Services (Medicare) Regulations 2017 or paragraph 31(b) of the former Human Services (Medicare) Regulations 1975; orsection 35 of the

(ii) an identification number was allocated, or purportedly allocated, as mentioned in paragraph 18(b) of the former Medicare Australia (Functions of Chief Executive Officer) Direction 2005; and

the allocation, or purported allocation, was by the use of a computer program;

(c) the Health Insurance Act 1973 had authorised the responsible person to do the following:

(i) arrange for the use of computer programs to allocate identification numbers under Human Services (Medicare) Regulations 2017 or paragraph 31(b) of the former Human Services (Medicare) Regulations 1975;section 35 of the

(ii) arrange for the use of computer programs to allocate identification numbers as mentioned in paragraph 18(b) of the former Medicare Australia (Functions of Chief Executive Officer) Direction 2005; and

such an arrangement had been in force.

before 1 July 2011—the Chief Executive Officer of Medicare Australia; or

on or after 1 July 2011—the Chief Executive Medicare.

(a) before the commencement of this item and for the purposes of the Health Insurance Act 1973, the responsible person, or a delegate of the responsible person, made a decision, or purportedly made a decision, to refuse to allocate to a person (the affected person) an identification number referred to:

(i) in Human Services (Medicare) Regulations 2017 or paragraph 31(b) of the former Human Services (Medicare) Regulations 1975; orsection 35 of the

(ii) in paragraph 18(b) of the former Medicare Australia (Functions of Chief Executive Officer) Direction 2005; and

the responsible person, or the delegate of the responsible person, took into account either or both of the following considerations:

(i) whether medicare benefits under the Health Insurance Act 1973 would have been payable in respect of professional services that would have been rendered by, or on behalf of, the affected person if a decision had been made to allocate an identification number to that person in relation to a place of practice requested by that person;

the adequacy or completeness of the affected person’s request;

before 1 July 2011—the Chief Executive Officer of Medicare Australia; or

on or after 1 July 2011—the Chief Executive Medicare.

the enactment of this Act; or

the amendments of regulations or any other instruments made under any Act, where those amendments are in connection with the enactment of this Act.

create an offence or civil penalty;

provide powers of:

arrest or detention; or

entry, search or seizure;

impose a tax;

set an amount to be appropriated from the Consolidated Revenue Fund under an appropriation in this Act;

directly amend the text of this Act.

be given electronically in accordance with the electronic system approved by the Chief Executive Medicare under section 333-16 for the purposes of this paragraph; and

include the information required by that system to be included in the notice; and

be accompanied by any documents required by that system to accompany the notice.

the notice complies with subsection 23-15(3); and

the criteria (if any) specified in the Private Health Insurance (Incentives) Rules for the purposes of this paragraph are met in relation to the application.

notify the private health insurer of the proposed refusal and the reasons for the proposed refusal; and

give the private health insurer an opportunity to amend and resubmit the notice given to the Chief Executive Medicare in relation to the application before the end of the period that applies in relation to section 23-20.

the period of 30 days commencing on the day the Chief Executive Medicare is notified of the application under subsection 23-15(2); or

if another period is specified in the Private Health Insurance (Incentives) Rules for the purposes of this paragraph—that specified period.

be given no more than 7 business days (or any other period determined by the Chief Executive Medicare under subsection (4)) after the withdrawal notice is received by the private health insurer; and

be given electronically in accordance with the electronic system approved by the Chief Executive Medicare under section 333-16 for the purposes of this paragraph; and

include the information required by that system to be included in the notice; and

be accompanied by any documents required by that system to accompany the notice.

the private health insurer is a *participating insurer when the premium is reduced; and

the premium is reduced in the 36 month period ending before the month in which the claim for reimbursement is made.

be made within 7 days after the end of a month; and

be given to the Chief Executive Medicare electronically in accordance with the electronic system approved by the Chief Executive Medicare under section 333-16 for the purposes of this paragraph; and

include the information required by that system to be included in the claim; and

be accompanied by any documents required by that system to accompany the claim.

the claim only includes amounts by which premiums under a *complying health insurance policy issued by the private health insurer have been reduced because of the operation of Division 23; and

the private health insurer was a *participating insurer when the premiums were reduced; and

the premiums were reduced in the 36 month period ending before the month in which the claim for reimbursement is made; and

the amounts have not previously been reimbursed to the private health insurer under this Division.

the Chief Executive Medicare receives a claim in accordance with section 279-10; and

the criteria specified in the Private Health Insurance (Incentives) Rules for the purposes of this paragraph have been met in relation to the claim;

if the criteria are not met in relation to part of the claim—refuse the claim in part and only pay the insurer, in accordance with section 279-15, the amount payable under that section in respect of such part of the claim that meets the specified criteria; or

otherwise—refuse the claim.

so much of a payment made under section 279-15 that is not an amount by which premiums under a complying health insurance policy issued by the private health insurer were reduced because of the operation of Division 23;

so much of a payment made under section 279-15 in relation to a claim for reimbursement as relates to a premium for which a reduction was made before the 36 month period ending before the month in which the claim was made;

so much of a payment made under section 279-15 as:

relates to a premium for which a reduction was made while the private health insurer was not a *participating insurer; or

relates to a premium for which a reduction was made where the amount of the reduction has previously been reimbursed to the private health insurer under Division 279;

the private health insurer relied on information provided to the private health insurer by, or on behalf of, a person who is, or was, a *participant in the *premiums reduction scheme; and

the provided information was incomplete or inaccurate.

a person who is covered at any time during a financial year specified in the notice by a *complying health insurance policy issued by the insurer; or

a person who paid premiums under such a policy; or

a claim made at any time by the insurer under the *premiums reduction scheme for reimbursement of premiums reduced under Division 23.

making, or refusing or failing to make, a decision under a provision mentioned in subsection (3); or

exercising, or refusing or failing to exercise, a power under a provision mentioned in subsection (3); or

performing, or refusing or failing to perform, a function or duty under a provision mentioned in subsection (3); or

doing, or refusing or failing to do, anything (including giving a notice) related to making a decision, exercising a power or performing a function or duty under a provision mentioned in subsection (3).

subsection 23-16(1) (which deals with registering a person as a *participant in the *premiums reduction scheme);

subsection 23-30(3) (which deals with revoking a person’s registration as a participant in the premiums reduction scheme);

subsection 23-40(2) (which deals with variations to registrations);

subsection 279-11(1) (which deals with reimbursement claims);

a provision of this Act prescribed by the Private Health Insurance (Incentives) Rules.

if the Chief Executive Medicare specifies a day on which the substituted action takes effect—that specified day; or

otherwise—the day of the administrative action taken by the operation of the computer program.

of the substituted decision and of the fact that the substituted decision was made by the Chief Executive Medicare; and

of the person’s right (if any) to apply for reconsideration of the substituted decision.

to the effect that the Chief Executive Medicare has made such an arrangement; and

setting out those particular provisions.

the total number of substituted actions taken by the Chief Executive Medicare under subsection 333-17(5) in that period;

the kind of substituted actions so taken;

the kind of administrative action taken by the operation of the computer program that the Chief Executive Medicare was satisfied was not correct.

was made before the commencement time; and

has not been dealt with, or taken to have been dealt with, by the Chief Executive Medicare before that time.

the notice was given before the commencement time; and

the period referred to in section 279-45 of the Act for making a request to the Chief Executive Medicare to reconsider the notified decision has not expired before the commencement time.

the notice is taken to be a notice given to the private health insurer in accordance with subsection 279-11(3) of the Act, as inserted by the amending Part; and

the private health insurer may request the Chief Executive Medicare to reconsider the decision by the end of the same period as the period referred to in paragraph (1)(b) of this item.

before the commencement time a person was registered, or purportedly registered, under section 23-15 of the Act as a participant in the premiums reduction scheme in respect of a complying health insurance policy issued by an insurer; and

a computer program was used in relation to the registration, under section 23-15 of the Act, of the person in the premiums reduction scheme in a way that was not authorised by the Act;

(c) the Act had authorised the responsible person to arrange for the use of computer programs to approve the registration of a person to become a participant in the premiums reduction scheme in respect of a complying health insurance policy; and

such arrangements had been in force; and

(e) the responsible person had been satisfied that paragraphs 23-15(1)(a), (b) and (c) of the Act (as in force at the time the computer program was used in relation to the registration of the person) applied in relation to the person.

before 1 July 2011—the Chief Executive Officer of Medicare Australia; or

on or after 1 July 2011—the Chief Executive Medicare.

before the commencement time the responsible person refused, or purportedly refused, to register a person as a participant in the premiums reduction scheme in respect of a complying health insurance policy issued by an insurer; and

a computer program was used in relation to the refusal to register the person in a way that was not authorised by the Act;

the Act had authorised the responsible person to arrange for the use of computer programs to refuse the registration of a person to become a participant in the premiums reduction scheme in respect of a complying health insurance policy; and

such arrangements had been in force; and

the responsible person had not been satisfied that paragraphs 23-15(1)(a), (b) and (c) of the Act (as in force at the time the computer program was used in relation to the refusal to register the person) applied in relation to the person.

before 1 July 2011—the Chief Executive Officer of Medicare Australia; or

on or after 1 July 2011—the Chief Executive Medicare.

before the commencement time the registration of a person as a participant in the premiums reduction scheme in respect of a complying health insurance policy issued by an insurer was revoked under subsection 23-30(3) of the Act; and

a computer program was used in relation to the revocation of the person’s registration in a way that was not authorised by the Act;

the Act had authorised the responsible person to arrange for the use of computer programs to revoke the registration of a person as a participant in the premiums reduction scheme in respect of a complying health insurance policy; and

such arrangements had been in force.

before 1 July 2011—the Chief Executive Officer of Medicare Australia; or

on or after 1 July 2011—the Chief Executive Medicare.

the enactment of this Act; or

the amendments of regulations or any other instruments made under any Act, where those amendments are in connection with the enactment of this Act.

create an offence or civil penalty;

provide powers of:

arrest or detention; or

entry, search or seizure;

impose a tax;

set an amount to be appropriated from the Consolidated Revenue Fund under an appropriation in this Act;

directly amend the text of this Act.

may specify circumstances in which enduring agreements:

may, or may not, be entered into; or

cease to be in effect; and

may specify kinds of professional services that enduring agreements may, or may not, apply to.

(c) under a complying health insurance policy issued by a private health insurer (the insurer), the assignor or another person is covered (wholly or partly) for liability to pay fees and charges in respect of the professional service; and

categories of professional services; and

the professional services that are in specified categories.

the insurer or approved billing agent does not give a notification to the assignor or, if the medicare benefit relates to a professional service rendered to another eligible person, to that other person:

in accordance with any requirements specified in the regulations; and

within 6 months of the payment.

the assignor asks the responsible provider for a copy of the terms of the request, as modified; and

the responsible provider does not ensure that the assignor is given a copy of the terms of the request, as modified, as soon as practicable after the assignor asks for it.

the person has completed their course of study in medicine at an Australian university; and

the person breaches the condition mentioned in paragraph 124ZG(1)(c).

that a bonded participant is taken to have completed a return of service obligation despite anything in Subdivision B;

that work completed by a person who is a bonded participant (including work completed before the person became a bonded participant) is taken to qualify for completing the person’s return of service obligation, despite anything in Subdivision B;