Health Insurance (Professional Services Review) Regulations 1999 (Cth)
made under the
This is a compilation of the
The notes at the end of this compilation
(the
The effect of uncommenced amendments is not shown in the text of the compiled law. Any uncommenced amendments affecting the law are accessible on the Legislation Register ( The details of amendments made up to, but not commenced at, the compilation date are underlined in the endnotes. For more information on any uncommenced amendments, see the series page on the Legislation Register for the compiled law.
If the operation of a provision or amendment of the compiled law is affected by an application, saving or transitional provision that is not included in this compilation, details are included in the endnotes.
For more information about any editorial changes made in this compilation, see the endnotes.
If the compiled law is modified by another law, the compiled law operates as modified but the modification does not amend the text of the law. Accordingly, this compilation does not show the text of the compiled law as modified. For more information on any modifications, see the series page on the Legislation Register for the compiled law.
If a provision of the compiled law has been repealed in accordance with a provision of the law, details are included in the endnotes.
Contents
These Regulations are the
Health Insurance (Professional Services Review) Regulations 1999 .
In these Regulations:
Act means theHealth Insurance Act 1973 .Note: Several other words and expressions used in these Regulations have the meaning given by the Act. The following are examples of words and expressions defined in Part VAA of the Act:
· adequate and contemporaneous records
· inappropriate practice
· person under review
· practitioner
· profession
· relevant period
· service.
This Part sets out the standards to be met in order that a practitioner’s records of the rendering or initiation of services be adequate and contemporaneous records.
Note: See subsection 82(3) of the Act for the significance of adequate and contemporaneous records.
For the definition of adequate and contemporaneous records in section 81 of the Act, the standard to be met in order that a record of service rendered or initiated be adequate is that:
(a) the record clearly identify the name of the patient; and
(b) the record contain a separate entry for each attendance by the patient for a service and the date on which the service was rendered or initiated; and
(c) each entry provide clinical information adequate to explain the type of service rendered or initiated; and
(d) each entry be sufficiently comprehensible that another practitioner, relying on the record, can effectively undertake the patient’s ongoing care.
For the definition of adequate and contemporaneous records in section 81 of the Act, the standard to be met in order that a record of a service rendered or initiated be contemporaneous, is that record must be completed:
(a) at the time the practitioner rendered or initiated the service; or
(b) as soon as practicable after the service was rendered or initiated by the practitioner.
For this Part:
professional attendance means a service of a kind mentioned in group A1, A2, A5, A6, A7, A9, A11, A13, A14, A15, A16, A17, A18, A19, A20, A21, A22 or A23 of Part 2 of the general medical services table.
This Part prescribes the circumstances in which services rendered or initiated by a practitioner constitute a prescribed pattern of services for Part VAA of the Act.
Note: See section 82 of the Act for how a prescribed pattern of services may constitute engaging in inappropriate practice.
For section 82A of the Act, the following groups of practitioners in theprofession of medicine are groups to which these Regulations apply:
(a) general practitioners;
(b) other medical practitioners rendering professional attendances.
For section 82A of the Act, the circumstances in which services that are professional attendances constitute a prescribed pattern of services are that 80 or more such services are rendered on each of 20 or more days in a 12 month period.
For subsection 82(1D) of the Act, the following circumstances are declared as constituting exceptional circumstances:
(a) an unusual occurrence causing an unusual level of need for professional attendances;
(b) an absence of other medical services, for patients of the person under review during the relevant period, having regard to:
(i) the location of the practice of the person under review; and
(ii) characteristics of the patients of the person under review.
(1) This section is made for the purposes of subsection 106C(1) of the Act and deals with allowances for expenses in respect of attendance by a person summoned to appear as a witness at a hearing before a Professional Service Review Committee.
Kinds of allowances (2) The allowances for a witness are the following:
(a) attendance allowance in accordance with subsection (3) or (4) as applicable;
(b) travel allowance in accordance with subsection (5).
Amount of attendance allowance (3) For a witness attending because of the witness’ professional, scientific or other special skill or knowledge the amount of attendance allowance is equal to the witness’ actual fees for preparing to give evidence and of attending to give evidence.
(4) For a witness other than a witness mentioned in subsection (3), the amount of attendance allowance is equal to:
(a) if the witness is paid by wages—any wages actually lost because of the attendance; or
(b) if the witness is paid by fees—any fees actually lost because of the attendance;
up to a maximum of $527 per day.
Amount of travel allowance (5) The amount of travel allowance for a witness is a reasonable amount, determined by the Professional Services Review Committee, for:
(a) transport to and from the hearing; and
(b) if the witness is required to be absent overnight from the witness’ usual place of residence—meals and accommodation during the absence.
For subsection 106XA(4) of the Act, the appropriate person or body for a person under review is a person or body specified in Schedule 1 that has the power to take action against the person under review in relation to any conduct by that person that has caused, is causing, or is likely to cause, a significant threat to the life or health of another person.
(1) For paragraph 106XB(3)(a) of the Act, the appropriate body for a person under review who is a general practitioner is a body specified in Part 1 of Schedule 1 that:
(a) is responsible for registering general practitioners or for regulating the practice of the profession; and
(b) has the power to take action against the person in relation to the person’s failure to comply with professional standards.
(2) For paragraph 106XB(3)(b) of the Act, the appropriate body for a person under review who is a practitioner other than a general practitioner is a body specified in Part 2 of Schedule 1 that:
(a) is responsible for registering practitioners for practice in the profession or specialty to which the practitioner belongs or for regulating the practice of that profession or specialty; and
(b) has the power to take action against the person in relation to the person’s failure to comply with professional standards.
(regulations 12 and 13)
101 | Medical Board of Australia |
102 | General Practice Recognition Appeal Committee |
103 | General Practice Recognition Eligibility Committee |
104 | The Royal Australian College of General Practitioners |
105 | Australian General Practice Accreditation Limited |
106 | Quality Practice Accreditation Pty Ltd trading as GPA Accreditation plus |
201 | Chiropractic Board of Australia |
202 | Dental Board of Australia |
203 | Department of Human Services |
204 | Medical Board of Australia |
205 | Nursing and Midwifery Board of Australia |
206 | Optometry Board of Australia |
207 | Osteopathy Board of Australia |
208 | Physiotherapy Board of Australia |
209 | Podiatry Board of Australia |
The endnotes provide information about this compilation and the compiled law.
The following endnotes are included in every compilation:
Endnote 1—About the endnotes
Endnote 2—Abbreviation key
Endnote 3—Legislation history
Endnote 4—Amendment history
The abbreviation key sets out abbreviations that may be used in the endnotes.
Amending laws are annotated in the legislation history and amendment history.
The legislation history in endnote 3 provides information about each law that has amended (or will amend) the compiled law. The information includes commencement details for amending laws and details of any application, saving or transitional provisions that are not included in this compilation.
The amendment history in endnote 4 provides information about amendments at the provision (generally section or equivalent) level. It also includes information about any provision of the compiled law that has been repealed in accordance with a provision of the law.
The
If the compilation includes editorial changes, the endnotes include a brief outline of the changes in general terms. Full details of any changes can be obtained from the Office of Parliamentary Counsel.
A misdescribed amendment is an amendment that does not accurately describe the amendment to be made. If, despite the misdescription, the amendment can be given effect as intended, the amendment is incorporated into the compiled law and the abbreviation “(md)” added to the details of the amendment included in the amendment history.
If a misdescribed amendment cannot be given effect as intended, the abbreviation “(md not incorp)” is added to the details of the amendment included in the amendment history.
ad = added or inserted | o = order(s) |
am = amended | Ord = Ordinance |
amdt = amendment | orig = original |
c = clause(s) | par = paragraph(s)/subparagraph(s) |
C[x] = Compilation No. x | /sub‑subparagraph(s) |
Ch = Chapter(s) | pres = present |
def = definition(s) | prev = previous |
Dict = Dictionary | (prev…) = previously |
disallowed = disallowed by Parliament | Pt = Part(s) |
Div = Division(s) | r = regulation(s)/rule(s) |
ed = editorial change | reloc = relocated |
exp = expires/expired or ceases/ceased to have | renum = renumbered |
effect | rep = repealed |
F = Federal Register of Legislation | rs = repealed and substituted |
gaz = gazette | s = section(s)/subsection(s) |
LA
= | Sch = Schedule(s) |
LIA
= | Sdiv = Subdivision(s) |
(md) = misdescribed amendment can be given | SLI = Select Legislative Instrument |
effect | SR = Statutory Rules |
(md not incorp) = misdescribed amendment | Sub‑Ch = Sub‑Chapter(s) |
cannot be given effect | SubPt = Subpart(s) |
mod = modified/modification | |
No. = Number(s) | commenced or to be commenced |
1999 No. 258 | 27 Oct 1999 | 1 Nov 1999 | |
1999 No. 346 | 22 Dec 1999 | 1 Jan 2000 | — |
2001 No. 45 | 16 Mar 2001 | 16 Mar 2001 | — |
2006 No. 199 | 28 July 2006 ( | 29 July 2006 | — |
2011 No. 120 | 30 June 2011 ( | 1 July 2011 | — |
2012 No. 212 | 3 Sept 2012 ( | 4 Sept 2012 | — |
2012 No. 298 | 7 Dec 2012 ( | 27 Dec 2012 | — |
Health Insurance (Repeal and Consequential Amendments) Regulations 2018 | 27 Sept 2018 (F2018L01366) | Sch 1 (item 19): 1 Oct 2018 (s 2(1) item 1) | — |
r 2............................................. | rep LA s 48D |
Note 1 to r. 3.............................. | am. 1999 No. 346 |
rep. 2012 No. 212 | |
Note 2 to r. 3.............................. | ad. 1999 No. 346 |
rep. 2012 No. 212 | |
Note to r. 3................................. | ad. 2012 No. 212 |
rs. 2012 No. 298 | |
Note to r. 4................................. | am. 2012 No. 212 |
Part 3......................................... | ad. 1999 No. 346 |
r. 7............................................. | ad. 1999 No. 346 |
am. 2001 No. 45; 2006 No. 199; 2012 No. 212 | |
Note to r. 7................................. | rep. 2012 No. 212 |
r. 8............................................. | ad. 1999 No. 346 |
am. 2012 No. 298 | |
r. 9............................................. | ad. 1999 No. 346 |
am. 2012 No. 298 | |
r. 10........................................... | ad. 1999 No. 346 |
am. 2012 No. 298 | |
r. 11........................................... | ad. 1999 No. 346 |
am. 2012 No. 298 | |
Note to r. 11............................... | rep. 2012 No. 212 |
Part 3A...................................... | ad F2018L01366 |
r 11A......................................... | ad F2018L01366 |
Part 4......................................... | ad. 2006 No. 199 |
rs. 2012 No. 298 | |
r. 12........................................... | ad. 2006 No. 199 |
am. 2012 No. 212 | |
rs. 2012 No. 298 | |
r. 13........................................... | ad. 2012 No. 298 |
Schedule 1.................................. | ad. 2006 No. 199 |
am. 2012 No. 212 | |
rs. 2012 No. 298 | |
Schedule 2.................................. | ad. 2006 No. 199 |
am. 2011 No. 120 | |
rs. 2012 No. 212 | |
rep. 2012 No. 298 |
0
0
0