Federal Register of Legislation - Australian Government

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SR 1999 No. 258 Regulations as amended, taking into account amendments up to SR 1999 No. 346
Registered 26 Mar 2010
Start Date 01 Jan 2000
End Date 15 Mar 2001
Date of repeal 23 Feb 2019
Repealed by Health Insurance (Professional Services Review Scheme) Regulations 2019

Health Insurance (Professional Services Review) Regulations 1999

Statutory Rules 1999 No. 258 as amended

made under the

Health Insurance Act 1973

Consolidated as in force on 12 January 2000

(includes amendments up to SR 1999 No. 346)

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


Health Insurance (Professional Services Review) Regulations 1999

Statutory Rules 1999 No. 258 as amended

made under the

 

 

 

Contents

Page

Part 1        Introductory

                        1  Name of Regulations [see Note 1]                                       3

                        2  Commencement                                                                3

                        3  Definition                                                                           3

Part 2        Adequate and contemporaneous records

                        4  Purpose of this Part                                                           4

                        5  An adequate record                                                            4

                        6  A contemporaneous record                                                 4

Part 3        Prescribed pattern of services

                        7  Definition                                                                           5

                        8  Purpose of this Part                                                           5

                        9  Practitioners affected by these Regulations                          5

                       10  Circumstances constituting a prescribed pattern                   5

                       11  Exceptional circumstances                                                 6

Notes                                                                                                         7

 

 


Part 1                 Introductory

  

1              Name of Regulations [see Note 1]

                These Regulations are the Health Insurance (Professional Services Review) Regulations 1999.

2              Commencement

                These Regulations commence on 1 November 1999.

3              Definition

                In these Regulations:

Act means the Health Insurance Act 1973.

Note 1   The expressions adequate and contemporaneous records, practitioner and service are defined in s 81 of the Act.

Note 2   The expressions Committee, inappropriate practice, person under review, profession, referred services and service are defined in s 81 of the Act.

Part 2                 Adequate and contemporaneous records

  

4              Purpose of this Part

                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 subs 82 (3) of the Act for the significance of adequate and contemporaneous records.

5              An adequate record

                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.

6              A contemporaneous record

                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.

Part 3                 Prescribed pattern of services

7              Definition

                For this Part:

professional attendance means a service of a kind mentioned in group A1, A2, A5, A6, A7, A13, A14 or A15 of Part 2 of the general medical services table.

Note   The expressions general medical services table, general practitioner and medical practitioner are defined in s 3 of the Act.

8              Purpose of this Part

                This Part prescribes the circumstances in which referred services constitute a prescribed pattern of services for Part VAA of the Act.

Note   Section 106KA of the Act provides that conduct of a person under review in connection with rendering or initiating services that constitute a prescribed pattern of services may be taken to be inappropriate practice.

9              Practitioners affected by these Regulations

                For subsection 106KA (3) of the Act, the following groups of practitioners in the profession of medicine are groups to which these Regulations apply:

                (a)    general practitioners;

               (b)    other medical practitioners rendering professional attendances.

10            Circumstances constituting a prescribed pattern

                The circumstance in which services that are professional attendances constitute a prescribed pattern of services is that 80 or more such services are rendered on each of 20 or more days in a 12 month period.

11            Exceptional circumstances

                For subsection 106KA (5) 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.

Note   For relevant period, see s 106KA of the Act.

 


Notes to the Health Insurance (Professional Services Review) Regulations 1999

Note 1

The Health Insurance (Professional Services Review) Regulations 1999 (in force under the Health Insurance Act 1973) as shown in this consolidation comprise Statutory Rules 1999 No. 258 amended as indicated in the Tables below.

Table of Statutory Rules

Year and
number

Date of notification
in Gazette

Date of
commencement

Application, saving or
transitional provisions

1999 No. 258

27 Oct 1999

1 Nov 1999

 

1999 No. 346

22 Dec 1999

1 Jan 2000

Table of Amendments

ad. = added or inserted      am. = amended      rep. = repealed      rs. = repealed and substituted

Provision affected

How affected

Note 1 to r. 3..........................

am. 1999 No. 346

Note 2 to r. 3..........................

ad. 1999 No. 346

Part 3.......................................
(rr. 7–11)

ad. 1999 No. 346

Rr. 7–11..................................

ad. 1999 No. 346