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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. 2)
Principal Regulations
Administered by: Health
Registered 02 Jan 2013
Start Date 27 Dec 2012
End Date 30 Sep 2018
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Repealed by Health Insurance (Professional Services Review Scheme) Regulations 2019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 person or body for person under review
Part 4 Appropriate person or body for person under review

Health Insurance (Professional Services Review) Regulations 1999

Statutory Rules 1999 No. 258 as amended

made under the

This compilation was prepared on 27 December 2012
taking into account amendments up to SLI 2012 No. 298

Prepared by the Office of Parliamentary Counsel, 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 person or body for person under review

                       12      Appropriate person or body for conduct involving significant threat to life or health   7

                       13      Appropriate body for non-compliance with professional standards   7

Schedule 1                  Appropriate person or body for a person under review  8

Part 1                             If person under review is a general practitioner                  8

Part 2                             If person under review is not a general practitioner            8

Notes                                                                                                            9

 


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. The following are examples of words and expressions defined in Part VAA of the Act:

·      adequate and contemporaneous records

·      inappropriate practice

·      person under review

·      practitioner

·      profession

·      relevant period

·      service.

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 services rendered or initiated by a practitioner constitute a prescribed pattern of services for Part VAA of the Act.

Note   See section 82 of the Act for how a prescribed pattern of services may constitute engaging in inappropriate practice.

9              Practitioners affected by these Regulations

                For section 82A 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

                For section 82A of the Act, the circumstances in which services that are professional attendances constitute a prescribed pattern of services are 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 82 (1D) 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 person or body for person under review

  

12            Appropriate person or body for conduct involving significant threat to life or health

                For subsection 106XA (4) of the Act, the appropriate person or body for a person under review is a person or body specified in Schedule 1 that has the power to take action against the person under review in relation to any conduct by that person that has caused, is causing, or is likely to cause, a significant threat to the life or health of another person.

13            Appropriate body for non-compliance with professional standards

         (1)   For paragraph 106XB (3) (a) of the Act, the appropriate body for a person under review who is a general practitioner is a body specified in Part 1 of Schedule 1 that:

                (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 person in relation to the person’s failure to comply with professional standards.

         (2)   For paragraph 106XB (3) (b) of the Act, the appropriate body for a person under review who is a practitioner other than a general practitioner is a body specified in Part 2 of Schedule 1 that:

                (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 person in relation to the person’s failure to comply with professional standards.

 


Schedule 1        Appropriate person or body for a person under review

(regulations 12 and 13)

Part 1          If person under review is a general practitioner

Item

Person or body

101

Medical Board of Australia

102

General Practice Recognition Appeal Committee

103

General Practice Recognition Eligibility Committee

104

The Royal Australian College of General Practitioners

105

Australian General Practice Accreditation Limited

106

Quality Practice Accreditation Pty Ltd trading as GPA Accreditation plus

Part 2          If person under review is not a general practitioner

Item

Person or body

201

Chiropractic Board of Australia

202

Dental Board of Australia

203

Department of Human Services

204

Medical Board of Australia

205

Nursing and Midwifery Board of Australia

206

Optometry Board of Australia

207

Osteopathy Board of Australia

208

Physiotherapy Board of Australia

209

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

2012 No. 298

7 Dec 2012 (see F2012L02370)

27 Dec 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

 

rs. 2012 No. 298

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

 

am. 2012 No. 298

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

ad. 1999 No. 346

 

am. 2012 No. 298

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

ad. 1999 No. 346

 

am. 2012 No. 298

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

ad. 1999 No. 346

 

am. 2012 No. 298

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

rep. 2012 No. 212

Part 4

 

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

ad. 2006 No. 199

 

rs. 2012 No. 298

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

ad. 2006 No. 199

 

am. 2012 No. 212

 

rs. 2012 No. 298

R. 13.......................................

ad. 2012 No. 298

Schedule 1

 

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

ad. 2006 No. 199

 

am. 2012 No. 212

 

rs. 2012 No. 298

Schedule 2

 

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

ad. 2006 No. 199

 

am. 2011 No. 120

 

rs. 2012 No. 212

 

rep. 2012 No. 298