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SR 1999 No. 258 Regulations as amended, taking into account amendments up to Health Insurance (Professional Services Review) Amendment Regulation 2012 (No. 1)
Principal Regulations
Administered by: Health
Registered 05 Sep 2012
Start Date 04 Sep 2012
End Date 26 Dec 2012
Date of repeal 23 Feb 2019
Repealed by Health Insurance (Professional Services Review Scheme) Regulations 2019
Table of contents.
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Collapse Part 1 Introductory 
Part 1 Introductory
1 Name of Regulations [see Note 1]
2 Commencement
3 Definition
Expand Part 2 Adequate and contemporaneous records 
Part 2 Adequate and contemporaneous records
Expand Part 3 Prescribed pattern of services 
Part 3 Prescribed pattern of services
Expand Part 4 Appropriate regulatory and other bodies for referral of professional issues 
Part 4 Appropriate regulatory and other bodies for referral of professional issues

Health Insurance (Professional Services Review) Regulations 1999

Statutory Rules 1999 No. 258 as amended

made under the

This compilation was prepared on 4 September 2012
taking into account amendments up to SLI 2012 No. 212

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                                                                                                          10

 


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   Several other words and expressions used in these Regulations have the meaning given by the Act. For example:

·      adequate and contemporaneous records (section 81)

·      Committee (section 81)

·      general medical services table (section 3)

·      general practitioner (section 3)

·      inappropriate practice (section 81)

·      medical practitioner (section 3)

·      person under review (section 81)

·      practitioner (section 81)

·      profession (section 81)

·      referred services (section 81)

·      relevant period (section 106KA)

·      service (section 81).


 

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 subsection 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 2 of the general medical services table.

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.

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, for a general practitioner:

                (a)    is responsible for registering 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, for a practitioner other than a general practitioner:

                (a)    is responsible for registering 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

Medical Board of Australia

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

Chiropractic Board of Australia

2

Dental Board of Australia

3

Department of Human Services

4

Medical Board of Australia

5

Nursing and Midwifery Board of Australia

6

Optometry Board of Australia

7

Osteopathy Board of Australia

8

Physiotherapy Board of Australia

9

Podiatry Board of 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.

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

2011 No. 120

30 June 2011 (see F2011L01364)

1 July 2011

2012 No. 212

3 Sept 2012 (see F2012L01822)

4 Sept 2012

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

 

rep. 2012 No. 212

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

ad. 1999 No. 346

 

rep. 2012 No. 212

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

ad. 2012 No. 212

Part 2

 

Note to r. 4.............................

am. 2012 No. 212

Part 3

 

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

ad. 1999 No. 346

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

ad. 1999 No. 346

 

am. 2001 No. 45; 2006 No. 199; 2012 No. 212

Note to r. 7.............................

rep. 2012 No. 212

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

ad. 1999 No. 346

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

ad. 1999 No. 346

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

ad. 1999 No. 346

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

ad. 1999 No. 346

Note to r. 11..........................

rep. 2012 No. 212

Part 4

 

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

ad. 2006 No. 199

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

ad. 2006 No. 199

 

am. 2012 No. 212

Schedule 1

 

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

ad. 2006 No. 199

 

am. 2012 No. 212

Schedule 2

 

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

ad. 2006 No. 199

 

am. 2011 No. 120

 

rs. 2012 No. 212