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.