Health Insurance (Pathology Services) Regulations

Legislation au C1977L00127 Regulations Not in force Legislative Instrument

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Statutory Rules

1977 No. 127

REGULATIONS UNDER THE HEALTH INSURANCE ACT 1973.*

I, THE GOVERNOR-GENERAL of the Commonwealth of Australia, acting with the advice of the Federal Executive Council, hereby make the following Regulations under the Health Insurance Act 1973.

Dated this twenty-eighth day of July, 1977.

JOHN R. KERR

Governor-General.

By His Excellency’s Command,

RALPH J. HUNT

Minister of State for Health.

 

HEALTH INSURANCE (PATHOLOGY SERVICES) REGULATIONS

Citation.

1. These Regulations may be cited as the Health Insurance (Pathology Services) Regulations.

Commencement.

2. Regulations 4, 5, 6 and 7 shall come into operation on 1 August 1977.

Interpretation.

3. In these Regulations, unless the contrary intention appears—

“ Director of Health ”—

(a) in relation to a State—means the officer of the Australian Public Service for the time being occupying, or performing the duties of, the office of Director of Health for that State; and

(b) in relation to a Territory—means the officer of the Australian Public Service for the time being occupying, or performing the duties of, the office of—

(i) in the case of the Australian Capital Territory—Director of Health for the State of New South Wales; and

(ii) in the case of the Northern Territory—Director of Health for the State of South Australia;

“ provider number ”, in relation to a practitioner or approved pathology practitioner, means the identification number that, for administrative purposes, is allocated to the practitioner or approved pathology practitioner by the Director-General or a person authorized by him for that purpose;

“ Territory ” means an internal Territory;

“ the Act ” means the Health Insurance Act 1973.

 

* Notified to the Commonwealth of Australia Gazette on 29 July 1977.

Prescribed pathology service.

4. Each pathology service to which Division 9 of Part 7 of the table relates is specified for the purposes of the definition of “prescribed pathology service” in sub-section 3 (1) of the Act.

Requests for pathology services.

5. (1) In this regulation, “ instrument ” means a request in writing, or a confirmation in writing of a request, referred to in paragraph 16a (1) (a) of the Act.

(2) For the purposes of paragraph 16a (1) (a) of the Act, an instrument shall, subject to sub-regulation (7), contain the particulars required by sub-regulations (3), (4), (5) and (6) to be specified in the instrument.

(3) An instrument shall specify, in respect of the practitioner, or approved pathology practitioner, by whom the request is, or was, made—

(a) in the case of a practitioner or an approved pathology practitioner who is a natural person—

(i) his surname and the initials of his given names, or, where he is, or was, at the time of making the request 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 practitioner or approved pathology practitioner, his surname and such of his given names as distinguish him from each of those other practitioners in that group; and

(ii) the address of his relevant place of practice or his provider number; and

(b) in the case of an approved pathology practitioner that is not a natural person—

(i) the full name of the approved pathology practitioner; and

(ii) the address of the relevant place of business of the approved pathology practitioner or the provider number of the approved pathology practitioner.

(4) An instrument shall specify, in respect of the approved pathology practitioner to whom the request is, or was, addressed—

(a) in the case of an approved pathology practitioner who is a natural person—

(i) his surname and the initials of his given names, or, where he is, or was, at the time of making the request 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 approved pathology practitioner, his surname and such of his given names as distinguish him from each of those other practitioners in that group; and

(ii) the address of the relevant place of business of the approved pathology practitioner; and

(b) in the case of an approved pathology practitioner that is not a natural person—

(i) the full name of the approved pathology practitioner; and

(ii) the address of the relevant place of business of the approved pathology practitioner.

(5) An instrument shall specify—

(a) the surname, and the initials of the given names, of the person in respect of whom the service is to be, or was, rendered and the address of that person;

(b) whether the person is, or was, at the time that the request was made a private patient in a recognized hospital;

(c) whether the request is being made, or was made, in the course of the provision of an out-patient service at a recognized hospital;

(d) each service to which the instrument relates; and

(e) the date on which each such service was determined to be necessary.

(6) An instrument shall, where the request is, or was, addressed to an approved pathology practitioner by another approved pathology practitioner who is not the practitioner who determined that the service was necessary, specify—

(a) if the request is, or was, made by the approved pathology practitioner to whom the request by that practitioner was addressed—the name, and the address or provider number, of that practitioner as specified in the instrument that relates to the request addressed by that practitioner to that approved pathology practitioner; or

(b) if the request is, or was, made by an approved pathology practitioner other than the approved pathology practitioner to whom the request by that practitioner was addressed—the name, and the address or provider number, of that practitioner as specified in the instrument that relates to the request addressed to that approved pathology practitioner by that other approved pathology practitioner.

(7) Where—

(a) a practitioner determines that a service is, or services are, necessary in relation to a person;

(b) the practitioner makes a request to an approved pathology practitioner in relation to that service or those services; and

(c) an approved pathology practitioner makes a request to another approved pathology practitioner in relation to that service or those services,

the instrument that relates to the request referred to in paragraph (c) (in this sub-regulation referred to as “ the first-mentioned instrument ”) shall not be required to include the particulars referred to in sub-regulations (5) and (6) if the instrument that relates to the request referred to in paragraph (b)—

(d) is annexed to the first-mentioned instrument; and

(e) relates to the service, or services, to which the first-mentioned instrument relates and no other service.

(8) Where an instrument is required by this regulation to specify any particulars of the kind referred to in paragraph (5) (d), those particulars shall be specified in the handwriting of the person signing the instrument.

(9) A request in writing, or a confirmation in writing of a request, by a practitioner referred to in sub-paragraph 16a (1) (a) (i) of the Act shall be signed by the practitioner.

(10) A request in writing, or a confirmation in writing of a request, by an approved pathology practitioner referred to in sub-paragraph 16a (1) (a) (ii) of the Act shall be signed—

(a) where the approved pathology practitioner is a natural person—by the approved pathology practitioner; or

(b) where the approved pathology practitioner is not a natural person—by a medical practitioner (being a medical practitioner who is an employee of the approved pathology practitioner) authorized by the approved pathology practitioner to sign for and on behalf of the approved pathology practitioner.

Particulars to be recorded on account, &c.

6. For the purposes of sub-section 16a (2) of the Act, the following particulars are prescribed:—

(a) where the account, receipt or form of agreement relates to a pathology service to which paragraph 16a (1) (a) of the Act applies—

(i) the name, and the address or provider number, of the practitioner, being 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;

(iii) the number of the item that relates to the service; and

(iv) if the pathology service was rendered by, or under the supervision of, an employee (being a medical practitioner) of an approved pathology practitioner (being the Commonwealth, a State, an authority established by a law of the Commonwealth or of a State or of a Territory, or a person referred to in paragraph (b) of the definition of “ eligible applicant ” in sub-section 16c (1) of the Act) in the course of his employment by the approved pathotogy practitioner—the surname, and the initials of the given names, of the employee and the employee’s provider number;

(b) where the account, receipt or form of agreement relates to a service to which paragraph 16a (1) (b) of the Act applies—

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

(ii) 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 given names, of the employee and the employee’s provider number;

(c) where the account, receipt or form of agreement relates to a service to which paragraph 16a (1) (c) of the Act applies—

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

(ii) 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 subparagraph was made and the surname, and the initials of the 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 given names, of the medical practitioner as distinguish him from each of those other members.

Service of notice under paragraph 16A (3) (b) of the Act.

7. For the purposes of paragraph 16a (3) (b) of the Act, a notice in writing referred to in that paragraph shall be served on an approved pathology practitioner—

(a) where the approved pathology practitioner is a natural person—by being delivered, or sent by pre-paid post, to the approved pathology

practitioner at the address for notices specified in the undertaking signed by the approved pathology practitioner under sub-section 16C (2) of the Act; or

(b) where the approved pathology practitioner is not a natural person—by being delivered, or sent by pre-paid post—

(i) if the approved pathology practitioner is an authority established by a law of the Commonwealth—to the principal place of business of the approved pathology practitioner; or

(ii) in any other case—to the address for notices specified in the undertaking signed on behalf of the approved pathology practitioner under sub-section 16c (2) of the Act.

Manner of giving undertaking, &c.

8. (1) A person shall—

(a) give an undertaking in writing under sub-section 16C (2) of the Act; or

(b) serve a notice of termination under sub-section 16C (8) of the Act,

by delivering it to the Director of Health for the State or Territory in which the prescribed place in relation to the person is situated or by sending it by pre-paid post to that Director of Health.

(2) In sub-regulation (1), “ prescribed place ”, in relation to a person, means the address specified in the undertaking signed by the person as the person’s address for notices.

Overview

The Health Insurance (Pathology Services) Regulations were made in 1977 under the Health Insurance Act 1973 by the Governor-General acting on the advice of the Federal Executive Council. These regulations address the need for a structured and formalised approach to the administration of pathology services under the health insurance system, ensuring that such services are efficiently managed and properly documented to facilitate accurate billing and compliance with the health insurance framework. They aim to ensure that pathology services are provided in accordance with the provisions of the Act by specifying the particulars that must be included in requests for pathology services and the manner in which these requests must be documented and communicated. The regulations also detail the process for giving undertakings and serving notices under the Act, further supporting the systematic administration of health insurance-related pathology services.

Scope and Application

The Health Insurance (Pathology Services) Regulations, made under the Health Insurance Act 1973, apply to the provision and administration of pathology services within Australia. These regulations cover both natural and legal persons who are either practitioners or approved pathology practitioners, as defined under the Act. They establish the requirements for instruments, such as written requests or confirmations, that must be adhered to when requesting pathology services. The regulations also specify the particulars that must be included in these instruments, including details about the practitioners, the patients, the services, and the dates. The regulations' jurisdiction extends to the entire Commonwealth of Australia, including the States and Territories, as evidenced by the roles assigned to Directors of Health in various jurisdictions. However, the regulations do not specify any exclusions, exemptions, or thresholds. Instead, they extend their application through subordinate instruments that may further detail specific aspects of the pathology services.

Key Provisions

The Health Insurance (Pathology Services) Regulations, which came into force on 1 August 1977, are established under the Health Insurance Act 1973. These regulations detail the specific pathology services that are covered under the Act and specify the requirements for instruments such as written requests or confirmations for pathology services (Regulations 4 and 5). Regulation 4 identifies pathology services related to Division 9 of Part 7 of the Act's table, while Regulation 5 outlines the particulars that must be included in an instrument requesting these services. This includes details about the practitioner making the request, the person for whom the service is intended, and the nature of the service itself (Regulation 5(3)-(6)). The Act imposes several obligations on the parties involved. Practitioners and approved pathology practitioners must provide specific details in their written requests, such as their full names and addresses, the patient's details, the nature of the requested services, and the date the necessity for the services was determined (Regulation 5). These requests must be signed by the practitioners (Regulations 9 and 10). Additionally, when pathology services are rendered, certain particulars must be recorded on accounts, receipts, or forms of agreement. These include the name and address of the practitioner who determined the necessity of the service, the date of determination, the relevant item number, and details of any employees involved in rendering the service (Regulation 6). Violations of the provisions under these regulations can lead to various penalties and consequences. While specific penalties are not detailed in the text, breaches of the Act's requirements could potentially result in civil or criminal sanctions. Such breaches might include failing to provide the necessary details in a written request or not recording the required particulars on accounts or receipts. The precise consequences would depend on the nature and severity of the breach, as well as any additional provisions under the Health Insurance Act 1973 or other related legislation.

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Instrument
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Definitions & Interpretation
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Sourced from the Federal Register of Legislation at 26 August 2026. For the latest information on Australian Government law please go to https://www.legislation.gov.au.