Health Insurance Regulations (Amendment) (Cth)

Statutory Rules 1996

No. 234 1

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Health Insurance Regulations 2(Amendment)

I, The Governor-General of the Commonwealth of Australia, acting with the advice of the Federal Executive Council, make the following Regulations under the Health Insurance Act 1973.

Dated 23 October 1996.

 WILLIAM DEANE

 Governor-General

By His Excellency’s Command,

MICHAEL WOOLDRIDGE

Minister for Health and Family Services

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1.   Commencement

1.1   These Regulations commence on 1 November 1996.

2.   Amendment

2.1   The Health Insurance Regulations are amended as set out in these Regulations.

3.   Regulation 13 (Particulars to be recorded on accounts, receipts and bulk billing agreement)

3.1   Add at the end:

 “(20) For the purposes of subsection 19 (6) of the Act, if the practitioner providing a professional service forms an opinion in accordance with subregulation (22) that the service is a hospital-related service within the meaning of subregulation (21), the following particular is prescribed in relation to the service—the letter ‘A’, except where the practitioner notifies the Commission, by means of an approved form known as a Form DB1C, of an assignment or agreement in relation to the medicare benefit in respect of the service.

 “(21) In subregulation (20):

‘hospital-related service’ means:

• (a)

  a professional service provided in relation to a person for a condition in relation to which the person will, or is likely to, receive treatment in a hospital or day hospital facility within 4 weeks of the service being provided,  for example, tests or x-rays performed prior to a person undergoing surgery in a hospital; or

(b)a professional service provided in relation to a person for a condition in relation to which the person had received treatment in a hospital or day hospital facility in the 4 weeks immediately before the service was provided; or

• (c)

  a professional service provided in relation to a person for a condition in relation to which, immediately before receiving the service, the person had presented for treatment to a recognised hospital and was referred or directed to the practitioner who provided the service; or

• (d)

  a professional service provided at a recognised hospital in relation to a person who is not admitted to that hospital in connection with that service.

 “(22) In forming the opinion mentioned in subregulation (20), the practitioner must have regard to the nature of the professional service and the circumstances in which it was provided including, but not limited to:

• (a)

  the results of any examination by the practitioner of the person in relation to whom the service was provided; and

• (b)

  the results of any tests in relation to the person conducted by, or made available to, the practitioner; and

• (c)

  the history and any other information given to the practitioner by the person; and

• (d)

  any letter, form or document given to the practitioner in connection with the provision by the practitioner of the service.”.

4.   Regulation 19 (Information that must be included in requests for diagnostic imaging services)

4.1   Subregulation 19 (1):

Add at the end:

• “(d)

  if the requesting practitioner forms an opinion in accordance with subregulation (1B) that the requested diagnostic imaging service is a hospital-related service within the meaning of subregulation (1A)—the letter ‘A’.”.

4.2   After subregulation 19 (1), insert :

 “(1A) In paragraph (1) (d):

‘hospital-related service’ means:

• (a)

  a diagnostic imaging service requested in relation to a person for a condition in relation to which the person will, or is likely to, receive treatment in a hospital or day hospital facility within 4 weeks of the service being provided, for example, tests performed prior to a person undergoing surgery in a hospital; or

(b)a diagnostic imaging service requested in relation to a person for a condition in relation to which the person had received treatment in a hospital or day hospital facility in the 4 weeks immediately before the provision of the service; or

• (c)

  a diagnostic imaging service requested in relation to a person, the request for which is made in connection with a condition in relation to which, immediately before receiving the service resulting in the making of the request, the person had presented for treatment to a recognised hospital and was referred or directed to the practitioner who provided that service; or

• (d)

  a diagnostic imaging service requested in connection with the provision of a professional service at a recognised hospital in relation to a person who is not admitted to that hospital in connection with the service.

 “(1B) In forming the opinion mentioned in paragraph (1) (d), the practitioner must have regard to the nature of the requested diagnostic imaging service and the circumstances in which the service is to be provided including, but not limited to:

• (a)

  the results of any examination by the practitioner of the person in relation to whom the service is to be provided; and

• (b)

  the results of any tests in relation to the person conducted by, or made available to, the practitioner; and

• (c)

  the history and any other information given to the practitioner by the person; and

• (d)

  any letter, form or document given to the practitioner in connection with the provision by the practitioner of a professional service to the person.”.

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NOTES

1. Notified in the Commonwealth of Australia Gazette on 30 October 1996.

2. Statutory Rules 1975 No. 80 as amended by 1975 Nos. 118, 125 and 135 (disallowed by the Senate on 4 September 1975); 1976 Nos. 202, 214 and 215; 1977 Nos. 26 and 44; 1978 Nos. 95 and 177; 1979 No. 230; 1981 Nos. 198 and 317; 1982 Nos. 157, 251 and 287; 1983 Nos. 106, 231, 253 and 255; 1984 Nos. 5 and 162; 1985 Nos. 36, 50, 95, 205 and 290; 1986 Nos. 19, 20, 87 and 326; 1987 Nos. 32, 163 and 166; 1988 No. 314; 1989 Nos. 6, 54, 117 and 293; 1990 No. 25; 1991 Nos. 82, 314, 365 and 441; 1992 Nos. 42, 111, 239, 335 and 431; 1993 Nos. 106, 130 and 154; 1994 Nos. 20, 27, 111, 137, 138, 328 and 413; 1995 Nos. 9, 25, 287, 300 and 409; 1996 No. 231.