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SR 1999 No. 258 Regulations as amended, taking into account amendments up to SLI 2006 No. 199
Principal Regulations
Administered by: Health
Registered 31 Jul 2006
Start Date 29 Jul 2006
End Date 30 Jun 2011
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Repealed by Health Insurance (Professional Services Review Scheme) Regulations 2019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

This compilation was prepared on 29 July 2006
taking into account amendments up to SLI 2006 No. 199

The text of any of those amendments not in force
on that date is appended in the Notes section

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


Contents

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

Part 4                    Appropriate regulatory and other bodies for referral of professional issues                                                                                       

                       12     Appropriate body for non-compliance with professional standards        7

Schedule 1             Regulatory and other bodies to which non-compliance by general practitioner may be referred                                                                         8

Schedule 2             Regulatory and other bodies to which non-compliance by practitioner other than a general practitioner may be referred                                         9

Notes                                                                                                          12

 


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, A9, A11, A13, A14, A15, A16, A17, A18, A19, A20, A21, A22 or A23 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.

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.

Part 4                 Appropriate regulatory and other bodies for referral of professional issues

12            Appropriate body for non-compliance with professional standards

         (1)   For paragraph 106XB (3) (a) of the Act, the appropriate body is a body specified in column 2 of an item in Schedule 1 that, in the State or Territory in which the general practitioner practises his or her practice:

                (a)    is responsible for registering or licensing general practitioners or for regulating the practice of the profession; and

               (b)    has the power to take action against the general practitioner in relation to the practitioner’s failure to comply with professional standards.

         (2)   For paragraph 106XB (3) (b) of the Act, the appropriate body is a body specified in column 2 of an item in Schedule 2 that, in the State or Territory in which the practitioner (being a practitioner other than a general practitioner) practises his or her practice or specialty:

                (a)    is responsible for registering or licensing practitioners for practice in the profession or specialty to which the practitioner belongs or for regulating the practice of that profession or specialty; and

               (b)    has the power to take action against the practitioner in relation to the practitioner’s failure to comply with professional standards.


Schedule 1        Regulatory and other bodies to which non-compliance by general practitioner may be referred

(subregulation 12 (1))

  

 

Item

Body

1

New South Wales Medical Board

Medical Practitioners Board of Victoria

Medical Board of Queensland

Medical Board of Western Australia

Medical Board of South Australia

Medical Council of Tasmania

Medical Board of the Australian Capital Territory

Medical Board of the Northern Territory

2

General Practice Recognition Appeal Committee

General Practice Recognition Eligibility Committee

Royal Australian College of General Practitioners

3

Australian General Practice Accreditation Limited

Quality Practice Accreditation Pty Ltd

Schedule 2        Regulatory and other bodies to which non-compliance by practitioner other than a general practitioner may be referred

(subregulation 12 (2))

  

 

Item

Body

1

New South Wales Medical Board

Medical Practitioners Board of Victoria

Medical Board of Queensland

Medical Board of Western Australia

Medical Board of South Australia

Medical Council of Tasmania

Medical Board of the Australian Capital Territory

Medical Board of the Northern Territory

2

Chiropractors Registration Board of New South Wales

Osteopaths Registration Board of New South Wales

Chiropractors Registration Board of Victoria

Osteopaths Registration Board of Victoria

Chiropractors Board of Queensland

Osteopaths Board of Queensland

Chiropractors Registration Board of Western Australia

Osteopaths Registration Board of Western Australia

Chiropractors Board of South Australia

Chiropractors and Osteopaths Registration Board of Tasmania

Chiropractors and Osteopaths Board of the Australian Capital Territory

Chiropractors and Osteopaths Board of the Northern Territory

3

Dental Board of New South Wales

Dental Practice Board of Victoria

Dental Board of Queensland

Dental Board of Western Australia

Dental Board of South Australia

Dental Board of Tasmania

Dental Board of the Australian Capital Territory

Dental Board of the Northern Territory

4

Optometrists Registration Board of New South Wales

Optometrists Registration Board of Victoria

Optometrists Board of Queensland

Optometrists Registration Board of Western Australia

Optometrists Board of South Australia

Optometrists Registration Board of Tasmania

Optometrists Board of the Australian Capital Territory

Optometrists Board of the Northern Territory

5

Physiotherapists Registration Board of New South Wales

Physiotherapists Registration Board of Victoria

Physiotherapists Board of Queensland

Physiotherapists Registration Board of Western Australia

Physiotherapists Board of South Australia

Physiotherapists Registration Board of Tasmania

Physiotherapists Board of the Australian Capital Territory

Physiotherapists Registration Board of the Northern Territory

6

Podiatrists Registration Board of New South Wales

Podiatrists Registration Board of Victoria

Podiatrists Board of Queensland

Podiatrists Registration Board of Western Australia

Podiatry Board of South Australia

Podiatrists Registration Board of Tasmania

Podiatrists Board of the Australian Capital Territory

7

Medicare Australia


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.

Under the Legislative Instruments Act 2003, which came into force on 1 January 2005, it is a requirement for all non-exempt legislative instruments to be registered on the Federal Register of Legislative Instruments.  From 1 January 2005 the Statutory Rules series ceased to exist and was replaced with Select Legislative Instruments (SLI series).  Numbering conventions remain the same, ie Year and Number.

Table of Instruments

Year and
number

Date of notification
in Gazette or FRLI registration

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

2006 No. 199

28 July 2006 (see F2006L02427)

29 July 2006

Table of Amendments

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

Provision affected

How affected

Part 1

 

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

am. 1999 No. 346

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

ad. 1999 No. 346

Part 3

 

Part 3......................................

ad. 1999 No. 346

R. 7.........................................

ad. 1999 No. 346

 

am. 2001 No. 45; 2006 No. 199

R. 8.........................................

ad. 1999 No. 346

R. 9.........................................

ad. 1999 No. 346

R. 10.......................................

ad. 1999 No. 346

R. 11.......................................

ad. 1999 No. 346

Part 4

 

Part 4......................................

ad. 2006 No. 199

R. 12.......................................

ad. 2006 No. 199

Schedule 1

 

Schedule 1............................

ad. 2006 No. 199

Schedule 2

 

Schedule 2............................

ad. 2006 No. 199