Federal Register of Legislation - Australian Government

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SR 1999 No 258 Regulations as amended, taking into account amendments up to SR 2001 No. 45
Administered by: Health
Start Date 16 Mar 2001
End Date 29 Jul 2006
Date of repeal 23 Feb 2019
Repealed by Health Insurance (Professional Services Review Scheme) Regulations 2019

HEALTH INSURANCE (PROFESSIONAL SERVICES REVIEW) REGULATIONS 1999



Compilation Information

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Health Insurance (Professional Services Review) Regulations 1999

Statutory Rules 1999 No. 258 as amended
made under the
Health Insurance Act 1973
This compilation was prepared on 16 March 2001
taking into account amendments up to SR 2001 No. 45
Prepared by the Office of Legislative Drafting,
Attorney-General's Department, Canberra

HEALTH INSURANCE (PROFESSIONAL SERVICES REVIEW) REGULATIONS 1999
Part 1 Introductory

HEALTH INSURANCE (PROFESSIONAL SERVICES REVIEW) REGULATIONS 1999
- REG 1
Name of Regulations [see Note 1]

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

HEALTH INSURANCE (PROFESSIONAL SERVICES REVIEW) REGULATIONS 1999
- REG 2
Commencement

These Regulations commence on 1 November 1999.

HEALTH INSURANCE (PROFESSIONAL SERVICES REVIEW) REGULATIONS 1999
- REG 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.

HEALTH INSURANCE (PROFESSIONAL SERVICES REVIEW) REGULATIONS 1999
Part 2 Adequate and contemporaneous records

HEALTH INSURANCE (PROFESSIONAL SERVICES REVIEW) REGULATIONS 1999
- REG 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.

HEALTH INSURANCE (PROFESSIONAL SERVICES REVIEW) REGULATIONS 1999
- REG 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:


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(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.

HEALTH INSURANCE (PROFESSIONAL SERVICES REVIEW) REGULATIONS 1999
- REG 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.

HEALTH INSURANCE (PROFESSIONAL SERVICES REVIEW) REGULATIONS 1999
Part 3 Prescribed pattern of services

HEALTH INSURANCE (PROFESSIONAL SERVICES REVIEW) REGULATIONS 1999
- REG 7
Definition

For this Part:

professional attendance means a service of a kind mentioned in group A1, A2, A5, A6, A7, A11, A13, A14, or A15 of Part 3 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.

HEALTH INSURANCE (PROFESSIONAL SERVICES REVIEW) REGULATIONS 1999
- REG 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.

HEALTH INSURANCE (PROFESSIONAL SERVICES REVIEW) REGULATIONS 1999
- REG 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.

HEALTH INSURANCE (PROFESSIONAL SERVICES REVIEW) REGULATIONS 1999
- REG 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.


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HEALTH INSURANCE (PROFESSIONAL SERVICES REVIEW) REGULATIONS 1999
- REG 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.

HEALTH INSURANCE (PROFESSIONAL SERVICES REVIEW) REGULATIONS 1999
- Note 1

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 compilation 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

2001 No. 45
16 Mar 2001
16 Mar 2001

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
R. 7
ad. 1999 No. 346

am. 2001 No. 45
Rr. 8-11
ad. 1999 No. 346