Health Insurance Regulations (Amendment) (Cth)

Statutory Rules 1983 No. 2551

Health Insurance Regulations2 (Amendment)

I, THE GOVERNOR-GENERAL of the Commonwealth of Australia, acting with the advice of the Federal Executive Council and in pursuance of section 4 of the Acts Interpretation Act 1901, hereby make the following Regulation under the Health Insurance Act 1973.

Dated 28 October 1983.

N. M. STEPHEN

Governor-General

By His Excellency’s Command,

Minister of State for Health

 

After regulation 2ad of the Health Insurance Regulations the following regulation is inserted:

Prescribed particulars for purposes of sub-section 19 (6) of the Act

“2ada. (1) For the purposes of sub-section 19 (6) of the Act, the following particulars are prescribed in relation to professional services generally:

(a) the surname, first Christian or given name, and initials of any subsequent Christian or given name, of the person to whom the professional service was rendered;

(b) the date on which the professional service was rendered, a description of the professional service sufficient to identify the item that relates to that service and the number of that item;

(c) where the professional service was rendered by a consultant physician, or a specialist, in the practice of his specialty to a patient who was referred to that consultant physician or specialist in the manner prescribed in sub-regulation 10 (2) by a person who, for the purposes of regulation 10, was a medical practitioner (in this paragraph referred to as the ‘referring medical practitioner)—

(i) the name of the referring medical practitioner, and

 

S.R. 261/83 Cat. No. Recommended retail price 40c 10/25.10.1983

 

(ii) the number of the referral form furnished by the referring medical practitioner under regulation 10 in respect of the patient.

“(2) For the purposes of sub-section 19 (6) of the Act, the following particular is prescribed in relation to professional services to which an item in Part 1 of the table relates, namely, where a practitioner or participating optometrist was in attendance on a person on more than one occasion on the same day and on each occasion rendered such a professional service on that person, the time at which each such attendance on that day commenced.

“(3) For the purposes of sub-section 19 (6) of the Act, the following particulars are prescribed in relation to professional services to which an item in Part 7 of the table relates:

(a) where the professional service is a pathology service to which paragraph 16a (1) (a) of the Act applies—

(i) the name and provider number of the practitioner who determined that the service was necessary as specified in the instrument that relates to the request addressed to the approved pathology practitioner by whom, or on whose behalf, the service was rendered;

(ii) the date on which the practitioner so determined that the service was necessary; and

(iii) if the pathology service was rendered under the supervision of an employee (being a medical practitioner) of an approved pathology practitioner who is not a medical practitioner in the course of his employment by the approved pathology practitioner—the surname, and the initials of the Christian or given names, of the employee and the employee’s provider number;

(b) where the professional service is a pathology service to which paragraph 16a(1) (b) of the Act applies—

(i) if the service was determined to be necessary by an employee (being a medical practitioner) of the approved pathology practitioner by whom or on whose behalf the service was rendered—the surname, and the initials of the Christian or given names, of the employee and the employee’s provider number; and

(ii) if the service was determined to be necessary by the person performing the service—the initials ‘s.d.’;

(c) where the professional service is a pathology service to which paragraph 16a (1) (c) of the Act applies—if the service was rendered in pursuance of a request of the kind referred to in sub-paragraph 16a (1) (c) (ii) of the Act—the date on which the request referred to in that sub-paragraph was made and the surname, and the initials of the Christian or given names, of the medical practitioner who determined that the service was necessary or, where at least one other member of the group of practitioners of which he is a member has the

 

same surname and the same initials as the medical practitioner, the surname, and such of the Christian or given names, of the medical practitioner as distinguish him from each of those other members.

“(4) For the purposes of sub-section 19 (6) of the Act, the following particulars are prescribed in relation to professional services to which an item in a Division (other than Division 9) of Part 7 or in Part 8, 8a, 9a or 11 of the table relates, namely, the name, address of the place of practice, and provider number, of the practitioner or approved pathology practitioner who—

(a) is claiming, or receiving, payment of fees in respect of such a professional service; or

(b) where an assignment has been made, or an agreement entered into, in accordance with section 20aof the Act, in relation to the medicare benefit in respect of such a professional service, is the assignee of the right to the payment of that benefit under that assignment or agreement.

“(5) For the purposes of sub-section 19 (6) of the Act, the following particulars are prescribed in relation to professional services other than professional services to which an item in a Division (other than Division 9) of Part 7 or in Part 8, 8a, 9a or 11 of the table relates:

(a) the name and address (being the address of the place of practice at which the service was rendered) of the practitioner or optometrist who rendered such a professional service together with a statement that the professional service was rendered by that person and—

(i) in a case where the service was rendered at a place of practice in respect of which the practitioner or optometrist (being a participating optometrist) has been allocated a provider number—that provider number;

(ii) in a case where the service was rendered on behalf of a participating optometrist by an optometrist who has not been allocated a provider number in respect of any place of practice—the provider number of the participating optometrist on whose behalf the service was rendered; and

(iii) in any other case—the provider number allocated to the practitioner or optometrist (being a participating optometrist) in respect of any place at which he practices;

(b) where the practitioner or optometrist referred to in paragraph (a) in relation to such a professional service is not the person who—

(i) is claiming, or receiving, payment of fees in respect of that professional service; or

(ii) where an assignment has been made, or an agreement entered into, in accordance with section 20a of the Act, in relation to the medicare benefit in respect of that professional service, is the assignee of the right to the payment of that benefit under that assignment or agreement,

the name, address of the place of practice, and provider number, of that person.”.

 

NOTES

1. Notified in the Commonwealth of Australia Gazette on 31 October 1983.

2. Statutory Rules 1975 No. 80 as amended to dale. For previous amendments see Note 2 to Statutory Rules 1983 No. 106 and see also Statutory Rules Nos. 106, 231 and 253

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