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Health Insurance Regulations (Amendment)

Authoritative Version
  • - F1996B02819
  • No longer in force
SR 1991 No. 365 Regulations as made
These Regulations amend the Health Insurance Regulations.
Administered by: Health
General Comments: This instrument was backcaptured in accordance with Section 36 of the Legislative Instruments Act 2003
Registered 01 Jan 2005
Tabling HistoryDate
Tabled Senate04-Dec-1991
Tabled HR19-Dec-1991
Gazetted 27 Nov 1991
Date of repeal 19 Mar 2014
Repealed by Health (Spent and Redundant Instruments) Repeal Regulation 2014

 

 

 

 

 

 

 

Statutory  Rules  1991   No. 365 1

__________________

 

 

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 20 November 1991.

 

                                                                                         BILL HAYDEN

                                                                                        Governor-General

          By His Excellency’s Command,

 

 

 

B. HOWE

Minister of State for Health, Housing

 and Community Services

____________

 

1.   Commencement

1.1   These Regulations commence on 1 December 1991.

 

 

2.   Amendment

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

 


 

3.   Regulation 2 (Interpretation)

3.1   Omit the regulation, substitute:

 

Interpretation

              “2.  In these Regulations, unless the contrary intention appears:

‘concessional beneficiary’ has the same meaning as in Part II of the Act;

‘patient contribution’ has the same meaning as in Part II of the Act;

‘prescribed GP service’ has the same meaning as in Part II of the Act;

‘provider number’ means the number that:

               (a)  is allocated by the Health Insurance Commission to a practitioner, an approved pathology practitioner or an optometrist; and

               (b)  identifies the person and the places where the person practises his or her profession;

‘referring practitioner’, in relation to a referral, means:

               (a)  in the case of all referrals—a medical practitioner; and

               (b)  if the referral is given to a specialist who is an ophthalmologist—an optometrist; and

               (c)  if the referral:

                           (i)  arises out of a dental service given by a dental practitioner; and

                          (ii)  is to a specialist (but not a consultant physician):

                     a dental practitioner;

‘requester number’ means the identification number allocated by the Health Insurance Commission to a chiropractor;

‘safety-net concession card’ has the same meaning as in Part II of the Act;

‘the Act’ means the Health Insurance Act 1973.”.

 

 

4.   Regulation 2ab (Definition of “professional service” in Act)

4.1   Omit “, being an item that includes the symbol ‘D’,”, substitute “in items 51700 to 53439 (inclusive) of the general medical services table”.

 

 

5.   New regulation 2ac

5.1   After regulation 2abd, insert:


 

Prescribed GP services

          “2ac.  For the purposes of paragraph (b) of the definition of ‘prescribed GP service’ in subsection 8 (1a) of the Act, the prescribed GP services are the services mentioned in the general medical services table in items 3, 4, 13, 20, 23, 24, 25, 35, 36, 37, 38, 43, 44, 47, 48, 51, 52, 53, 54, 57, 58, 59, 60, 65, 81, 83, 84, 86, 92, 93, 95, 96, 97 (other than for attendance at a hospital), 98 and 173.”.

 

 

6.   Regulation 2adaaa (Dental practitioners may only request certain diagnostic imaging services)

6.1   Omit the regulation, substitute:

 

Diagnostic imaging services which dental practitioners may request

   “2adaaa.  For the purposes of subsection 16b (2) of the Act, the services are those mentioned in the diagnostic imaging services table in items 57900 to 57945 (inclusive).”.

 

 

7.   Regulation 2adaab(Chiropractors may only request certain diagnostic imaging services)

7.1   Omit the regulation, substitute:

 

Diagnostic imaging services which chiropractors may request

   “2adaab.  For the purposes of subsection 16b (3) of the Act, the services are those mentioned in the diagnostic imaging services table in items 57712, 57715, 57718 and 58100 to 58118 (inclusive).”.

 

 

8.   Regulation 2adaac (Exemption—pre-existing diagnostic imaging practices)

8.1   Omit the regulation, substitute:

 

Exemption—pre-existing diagnostic imaging practices

   “2adaac.  For the purposes of subsection 16b (11) of the Act, the services are those mentioned in the diagnostic imaging services table in items 57712, 57715, 57718, 57900, 57903, 57912, 57915, 57921, 58100 to 58118 (inclusive), 58521, 58524, 58527, 58700, 58924 and 59103.”.

 


 

9.   Regulation 2ada (Particulars to be provided by referring practitioner)

9.1   Subregulation 2ada (1):

Omit the subregulation.

 

9.2   Subregulation 2ada (1a):

Omit paragraphs (a) and (b), substitute:

             “(a)  the name of the patient to whom the service was given;

               (b)  the date on which the service was given;

               (c)  the number (if any) that identifies the patient as a concessional beneficiary, or the holder of a safety-net concession card, if the service is a prescribed GP service;

              (d)  the amount of the patient contribution for the service if:

                           (i)  the service is a prescribed GP service; and

                          (ii)  the patient has assigned, under section 20a of the Act, his or her right to the payment of benefit for the service.”.

 

9.3   Subregulation 2ada (1b):

Omit “paragraph 10 (2) (a) by a referring medical”, substitute:

“regulation 10 by a referring”.

 

9.4   Paragraph 2ada (1b) (a):

Omit “medical”.

 

9.5   Paragraph 2ada (1b) (b):

Omit “medical”.

 

9.6   Paragraph 2ada (1b) (c):

Omit “medical”.

 

9.7   Subregulation 2ada (1b):

Add at the end:

             “(d)  the period of validity of the referral applicable under regulation 12.”.

 

9.8   Subregulation 2ada (1c):

Omit the subregulation, substitute:

           “(1c)  For the purposes of subsection 19 (6) of the Act, if a referral is given under subregulation 11 (1) the words, ‘referral within (insert the

name of the hospital in which the referral was given)’ are prescribed.”.

 

9.9   Subregulation 2ada (1d):

Omit “medical” (wherever occurring).

 

9.10   Paragraph 2ada (1d) (b):

Omit “special circumstances—”.

 

9.11   Subregulation 2ada (1e):

Omit the subregulation, substitute:

           “(1e)  For the purposes of subsection 19 (6) of the Act, the word ‘emergency’ is prescribed if:

               (a)  a referring practitioner; or

               (b)  a specialist or consultant physician in the practice of his or her speciality;

decides in an emergency that it is necessary in the patient’s interests for a professional service to be given as soon as practicable.”.

 

9.12   Subregulation 2ada (2):

Omit “Part 1 of the”, substitute:

“items 3 to 10929 (inclusive) of the general medical services”.

 

9.13   Subregulation 2ada (2):

Omit “participating”.

 

9.14   Subregulation 2ada (4):

Omit “an item in Part 8a or 11”, substitute “any of items 12500 to 12530 (inclusive), 15000 to 15533 (inclusive) and 16000 to 16012 (inclusive)”.

 

9.15   Subregulation 2ada (4a):

Omit “in a Division (other than Division 9) of the pathology services table”, substitute:

“in the pathology services table, other than items 73801 to 73811 (inclusive),”.

 

9.16   Subregulation 2ada (5):

Omit “in a Division (other than Division 9) of the pathology services table, an item in Part 8a or 11”, substitute:

“in the pathology services table, other than items 73801 to 73811 (inclusive), or any of items 12500 to 12530 (inclusive), 15000 to 15533 (inclusive) and 16000 to 16012 (inclusive)”.

 


 

9.17   Subparagraph 2ada (5) (a) (i):

Omit “(being a participating optometrist)”.

 

9.18   Subparagraph 2ada (5) (a) (ii):

Omit the subparagraph.

 

9.19   Subparagraph 2ada (5) (a) (iii):

Omit “(being a participating optometrist)”.

 

9.20   Paragraph 2ada (5) (b):

Omit the paragraph.

 

 

10.   Regulation 10 (Manner of referral to specialists or consultant physicians)

10.1   Omit the regulation, substitute:

 

Referral to specialists or consultant physicians

            “10.  (1)   This regulation and regulations 11 and 12 apply for the purposes of subsection 133 (2) of the Act if the general medical services table provides for a professional service mentioned in an item to be given by a specialist, or consultant physician, in the practice of his or her speciality, on referral of the patient by a referring practitioner.

 

             “(2)  The referring practitioner must consider the need for the referral.

 

             “(3)  The referral must give the specialist, or consultant physician, any information about the patient’s condition that the referring practitioner considers necessary.

 

             “(4)  Unless subregulation 11 (1) or (2) applies, a referral must be:

               (a)  given in writing; and

               (b)  signed by the referring practitioner; and

               (c)  dated.

 

             “(5)  Unless subregulation 11 (3) applies, the specialist or consultant physician must receive the referral before giving the service to the patient.


 

Referrals: special cases

            “11.  (1)    A referral is given for a professional service to an in-patient in a hospital who is not a public patient if the hospital records record the referring practitioner’s signature approving the referral.

 

             “(2)  A referral need not be given in writing if the referring practitioner decides in an emergency that it is necessary in the patient’s interests for the patient to be referred to the specialist or consultant physician as soon as practicable without a written referral.

 

             “(3)  Subregulation 10 (5) does not apply if a written referral is lost, stolen or destroyed.

 

             “(4)  A referral is not required for a professional service given in an emergency by a specialist or consultant physician who decides that it is necessary in the patient’s interests to give the service as soon as practicable without a referral.

 

 

Validity of referrals to specialists or consultant physicians

            “12.  (1)   A referral given under regulation 10 is valid:

               (a)  if the referral provides for it to be valid for a fixed period—for the period so provided; or

               (b)  if the referral provides for it to be valid indefinitely—for an indefinite period; or

               (c)  if the referral does not provide for its validity—for 12 months after the first service given in accordance with the referral.

 

             “(2)  A referral given under subregulation 11 (1) is valid until the patient ceases to be an in-patient in the hospital who is not a public patient.

 

             “(3)  A referral given under subregulation 11 (2) is valid for only 1 attendance on the patient.

 

             “(4)  A written referral that is lost, stolen or destroyed is valid for only 1 attendance on the patient.”.

 


 

NOTES

1.      Notified in the Commonwealth of Australia Gazette on 27 November 1991.

 

2.      Statutory Rules 1975 No. 80 as amended by 1975 Nos. 118, 125 and 135 (commenced 3 July 1975; disallowed 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 (commenced 7 November 1985; disallowed 15 April 1986); 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 and 314.