Health Insurance (Pathology Services) Regulations 1989

Health Insurance (Pathology Services) Regulations 1989

Statutory Rules 1989 No. 75 as amended

made under the

Health Insurance Act 1973

This compilation was prepared on 1 August 2012
taking into account amendments up to SLI 2012 No. 166

Prepared by the Office of Legislative Drafting and Publishing,
Attorney-General’s Department, Canberra

Contents

 1 Name of Regulations [see Note 1]

 2 Repeal of former Health Insurance (Pathology Services) Regulations             

 3 Interpretation 

 4 Requests for pathology services 

 5 Termination of undertaking — sections 23DE and 23DH of the Act             

Notes  

1 Name of Regulations [see Note 1]

  These Regulations are the Health Insurance (Pathology Services) Regulations 1989.

2 Repeal of former Health Insurance (Pathology Services) Regulations

  Statutory Rules 1977 No. 127, 1979 No. 66, 1983 Nos. 254 and 256 and 1984 No. 6 are repealed.

3 Interpretation

  In these Regulations, unless the contrary intention appears:

the Act means the Health Insurance Act 1973.

4 Requests for pathology services

 (1) In this regulation, unless the contrary intention appears:

provider number, in relation to a practitioner or an approved pathology practitioner, has the same meaning as in the Health Insurance Regulations.

relevant address, in relation to a treating practitioner or an approved pathology practitioner, who makes a request, means:

 (a) where the request is made from a place of practice of the treating practitioner or approved pathology practitioner — the address of that place; or

 (b) where paragraph (a) does not apply — the address of any place of practice of the treating practitioner or approved pathology practitioner.

request means a request for a pathology service (other than a pathologist-determinable service to which subsection 16A (6) of the Act applies) made in accordance with subsection 16A (3) of the Act.

treating practitioner  has the same meaning as in section 16A of the Act.

 (2) For paragraph 16A (4) (b) of the Act, a request must, subject to subregulation (9), contain the particulars required by subregulations (3), (5), (6) and (8).

Note   A request in respect of a person who is a private hospital patient may also contain information about the person’s private health insurance — see subregulation (5A).

 (3) A request shall include the following particulars in respect of the treating practitioner, or approved pathology practitioner, who makes the request (in this subregulation called the requesting practitioner):

 (a) the surname and the initials of the given names of
the requesting practitioner or, where the requesting practitioner is a member of a group of practitioners, being practitioners at least one other of whom has the same surname and the same initials as the requesting practitioner, the surname and such of the given names of the requesting practitioner as would distinguish him or her from each of those other practitioners in that group;

 (b) the relevant address; and

 (c) the provider number that relates to the place of practice of the requesting practitioner at that address.

 (5) A request shall include the following particulars in respect of the person in relation to whom the service is requested:

 (a) the name of the person;

 (b) the address of the person;

 (c) whether the person is:

 (i) a public patient in a recognized hospital;

 (ii) a private patient in a recognized hospital;

 (iii) a private patient in a private hospital; or

 (iv) a private patient in a day hospital facility;

 (d) whether the request is made in the course of the provision in relation to the person of an out-patient service at a recognized hospital.

 (5A) A request for a service in respect of a person described in subparagraph (5) (c) (ii), (iii) or (iv) may include the following particulars for the purpose of a private health insurance claim in relation to the service, if the person consents to the inclusion of those particulars for that purpose:

 (a) the name of the private health insurance fund of which the person is a member;

 (b) the membership number or other unique identifier allocated to the person by the fund.

 (5B) Failure by a person to consent to the inclusion of the particulars mentioned in subregulation (5A) in a request for a service in respect of the person does not affect any entitlement the person may have to a medicare benefit, or a benefit payable by a private health insurance fund, in respect of the service.

 (6) A request shall include the following particulars in respect of the service, or each service, requested:

 (a) a description of the service in terms or symbols that:

 (i) would be generally understood by medical practitioners; and

 (ii) are sufficient to identify the service for the purpose of ascertaining the item (if any) in which that service is specified;

 (b) the date on which the service was determined to be necessary;

 (c) whether the service is a pathology service in relation to a bodily specimen obtained from a person while the person was an in-patient of a hospital or day hospital facility that is to be performed after the person has ceased to be such a patient.

 (7) Subregulations (8) and (9) apply if:

 (a) a treating practitioner makes a request (the first request) for a service that is received by an approved pathology practitioner (the referring pathologist); and

 (b) the referring pathologist makes a request (the further request) for the service to an approved pathology authority or another approved pathology practitioner.

 (8) The further request must include the treating practitioner’s name, relevant address and provider number mentioned in the first request.

 (9) The further request need not comply with subregulations (5), (6) and (8) if:

 (a) the further request relates only to the service to which the first request relates; and

 (b) the first request is attached to the further request.

5 Termination of undertaking — sections 23DE and 23DH of the Act

  For the purposes of sections 23DE and 23DH of the Act, a notice of termination shall be given by addressing it, and sending it by pre-paid post, to the Minister at the Department of Human Services, P.O. Box 1001, Tuggeranong, A.C.T. 2901.

Notes to the Health Insurance (Pathology Services) Regulations 1989

Note 1

The Health Insurance (Pathology Services) Regulations 1989 (in force under the Health Insurance Act 1973) as shown in this compilation comprise Statutory Rules 1989 No. 75 amended as indicated in the Tables below.

Table of Instruments

Table of Amendments