1 Name of Regulations
These Regulations are the Health Insurance Regulations 1975.
2 Interpretation
(1) In these Regulations:
ACRRM means the Australian College of Rural and Remote Medicine.
Appeal Committee means the General Practice Recognition Appeal Committee established under the Health Insurance (Vocational Registration of General Practitioners) Regulations.
approved collection centre has the same meaning as in Part IIA of the Act.
collaborative arrangement:
(a) for a participating midwife—means a collaborative arrangement mentioned in regulation 2C; or
(b) for a participating nurse practitioner—means a collaborative arrangement mentioned in regulation 2F.
Complaints Unit means the Complaints Unit of the Department of Health of New South Wales.
Health Department means the Department administered by the Minister responsible for administering these regulations.
identification number, in relation to a licensed collection centre, means the identification number allocated to the centre under section 23DNF of the Act.
investigation means:
(a) in relation to the Chief Executive Medicare—the investigation by the Chief Executive Medicare of:
(i) a contravention, or possible contravention, of the Act or these regulations; or
(ii) the provision, or possible provision, of:
(A) excessive pathology services; or
(B) services that are excessive services within the meaning of Division 3 or 3A of Part V of the Act; or
(b) in relation to the Complaints Unit—the investigation by the Unit of a complaint under the Medical Practitioners Act 1938 of New South Wales.
(K) item means an item of the diagnostic imaging services table that includes the symbol (K) at the end of the item.
Medical Board means an authority specified in Part 4 or 5 of Schedule 3.
National Law means the Health Practitioner Regulation National Law set out in the Schedule to the Health Practitioner Regulation National Law Act 2009 (Qld).
(NK) item means an item of the diagnostic imaging services table that includes the symbol (NK) at the end of the item.
Nursing and Midwifery Board means the Nursing and Midwifery Board of Australia established under section 31 of the National Law.
obstetrician means a medical practitioner who is a specialist in the specialty of obstetrics and gynaecology (however described).
obstetric specified medical practitioner means a medical practitioner mentioned in paragraph 2B(1)(a) or (b).
paediatrician means a medical practitioner who is a specialist in the specialty of paediatrics and child health (however described).
patient episode means a pathology service, or pathology services whether listed in 1 or more items in the Pathology Services Table, for a single patient whose need for which was determined under subsection 16A(1) of the Act on the same day, whether rendered by 1 or more approved pathology practitioners on 1 or more days.
provider number means the number that:
(a) is allocated by the Chief Executive Medicare to a practitioner, approved pathology practitioner, optometrist, participating midwife or participating nurse practitioner; and
(b) identifies the person and the places where the person practises his or her profession.
RACGP means the Royal Australian College of General Practitioners.
referring practitioner, in relation to a referral, means:
(a) in the case of all referrals—a medical practitioner; and
(b) if the referral is given to a specialist who is an ophthalmologist—an optometrist; and
(c) if the referral:
(i) arises out of a dental service given by a dental practitioner; and
(ii) is to a specialist (but not a consultant physician):
a dental practitioner; and
(d) if the referral:
(i) arises out of a midwifery service provided by a participating midwife; and
(ii) is to an obstetrician or paediatrician;
a participating midwife; and
(e) if the referral:
(i) arises out of a nurse practitioner service provided by a participating nurse practitioner; and
(ii) is to a specialist or consultant physician;
a participating nurse practitioner.
requester number means the identification number allocated by the Chief Executive Medicare to a chiropractor, osteopath, physiotherapist or podiatrist.
servicing provider means a treatment provider rendering treatment on behalf of another treatment provider.
specified medical practitioner:
(a) for a participating midwife—means a medical practitioner mentioned in regulation 2B; or
(b) for a participating nurse practitioner—means a medical practitioner mentioned in regulation 2F.
the Act means the Health Insurance Act 1973.
treatment provider means:
(a) a practitioner; or
(b) an approved pathology practitioner; or
(c) an optometrist; or
(d) a participating midwife; or
(e) a participating nurse practitioner.
upgraded, for equipment, has the meaning given by the diagnostic imaging services table.
usual general practitioner, for a patient, includes a medical practitioner nominated by the patient.
Note: Several other words and expressions used in these Regulations have a meaning given by subsection 3(1) of the Act. For example:
· consultant physician
· eligible midwife
· eligible nurse practitioner
· general practitioner
· hospital‑substitute treatment
· hospital treatment
· medical practitioner
· midwife
· nurse practitioner
· participating midwife
· participating nurse practitioner
· practitioner
· private health insurer
· specialist.
(2) For subsection 3(20) of the Act, specialist trainee means a medical practitioner who is enrolled in and undertaking a training program with a medical college, within the meaning of section 3GC of the Act.
2A General practitioners
For paragraph (c) of the definition of general practitioner
in subsection 3(1) of the Act, a medical practitioner for whom a determination is in force under regulation 6DA recognising that he or she meets fellowship standards of the ACRRM is specified.
2B Specified medical practitioners
(1) For the definition of participating midwife in subsection 3(1) of the Act, the following kinds of medical practitioner are specified:
(a) an obstetrician;
(b) a medical practitioner who provides obstetric services;
(c) a medical practitioner employed or engaged by a hospital authority and authorised by the hospital authority to participate in a collaborative arrangement.
(2) For the definition of participating nurse practitioner in subsection 3(1) of the Act, all kinds of medical practitioner are specified.
(3) In this regulation:
hospital authority has the meaning given by subsection 84(1) of the National Health Act 1953.
2C Collaborative arrangements—participating midwives
(1) For the definition of participating midwife in subsection 3(1) of the Act, each of the following is a kind of collaborative arrangement for an eligible midwife:
(a) an arrangement under which the midwife:
(i) is employed or engaged by one or more obstetric specified medical practitioners, or by an entity that employs or engages one or more obstetric specified medical practitioners; or
(ii) has an agreement, in writing, with an entity, other than a hospital, that employs or engages one or more obstetric specified medical practitioners;
(b) a patient is referred in writing to the midwife for midwifery treatment by a specified medical practitioner;
(c) an agreement mentioned in regulation 2D for the midwife;
(d) an arrangement mentioned in regulation 2E for the midwife;
(e) an arrangement mentioned in regulation 2EA for the midwife.
(2) For subregulation (1), the arrangement must provide for:
(a) consultation between the midwife and an obstetric specified medical practitioner; and
(b) referral of a patient to a specified medical practitioner; and
(c) transfer of a patient’s care to an obstetric specified medical practitioner.
(3) A collaborative arrangement, other than an arrangement mentioned in regulation 2E, may apply to more than 1 patient.
(4) However, an acknowledgement mentioned in paragraph 2E(1)(c) may apply for more than 1 patient.
(5) To avoid doubt, a collaborative arrangement may involve a specified medical practitioner who is in private practice or in the public sector.
2D Agreement between eligible midwife and 1 or more specified medical practitioners
(1) An agreement may be made between:
(a) an eligible midwife; and
(b) 1 or more specified medical practitioners.
(2) The agreement must be in writing and signed by the eligible midwife and the other parties mentioned in paragraph (1)(b).
2E Arrangement—midwife’s written records
(1) An eligible midwife must record the following for a patient in the midwife’s written records:
(a) the name of at least 1 specified medical practitioner who is, or will be, collaborating with the midwife in the patient’s care (a named medical practitioner);
(b) that the midwife has told the patient that the midwife will be providing midwifery services to the patient in collaboration with 1 or more specified medical practitioners in accordance with this regulation;
(c) acknowledgement by a named medical practitioner that the practitioner will be collaborating in the patient’s care;
(d) plans for the circumstances in which the midwife will do any of the following:
(i) consult with an obstetric specified medical practitioner;
(ii) refer the patient to a specified medical practitioner;
(iii) transfer the patient’s care to an obstetric specified medical practitioner.
(2) The midwife must also record the following in the midwife’s written records:
(a) any consultation or other communication between the midwife and an obstetric specified medical practitioner about the patient’s care;
(b) any referral of the patient by the midwife to a specified medical practitioner;
(c) any transfer by the midwife of the patient’s care to an obstetric specified medical practitioner;
(d) when the midwife gives a copy of the hospital booking letter (however described) for the patient to a named medical practitioner—acknowledgement that the named medical practitioner has received the copy;
(e) when the midwife gives a copy of the patient’s maternity care plan prepared by the midwife to a named medical practitioner—acknowledgement that the named medical practitioner has received the copy;
(f) if the midwife requests diagnostic imaging or pathology services for the patient—when the midwife gives the results of the services to a named medical practitioner;
(g) that the midwife has given a discharge summary (however described) at the end of the midwife’s care for the patient to:
(i) a named medical practitioner; and
(ii) the patient’s usual general practitioner.
2EA Arrangement—midwife credentialed for a hospital
(1) For paragraph 2C(1)(e), in relation to a hospital, an eligible midwife is:
(a) credentialed to provide midwifery services after successfully completing a formal process to assess the midwife’s competence, performance and professional suitability; and
(b) given clinical privileges for a defined scope of clinical practice for the hospital; and
(c) permitted to provide midwifery care to his or her own patients at the hospital.
(2) The hospital must employ or engage one or more obstetric specified medical practitioners.
2F Collaborative arrangements—participating nurse practitioners
(1) For the definition of participating nurse practitioner in subsection 3(1) of the Act, each of the following is a kind of collaborative arrangement for an eligible nurse practitioner:
(a) the nurse practitioner is employed or engaged by 1 or more specified medical practitioners, or by an entity that employs or engages 1 or more specified medical practitioners;
(b) a patient is referred in writing to the nurse practitioner for treatment by a specified medical practitioner;
(c) an agreement mentioned in regulation 2G for the nurse practitioner;
(d) an arrangement mentioned in regulation 2H for the nurse practitioner.
(2) For subregulation (1), the arrangement must provide for:
(a) consultation between the nurse practitioner and a medical practitioner; and
(b) referral of a patient to a medical practitioner; and
(c) transfer of a patient’s care to a medical practitioner.
(3) A collaborative arrangement, other than an arrangement mentioned in regulation 2H, may apply to more than 1 patient.
(4) However, an acknowledgement mentioned in paragraph 2H(1)(c) may apply for more than 1 patient.
2G Agreement between eligible nurse practitioner and 1 or more specified medical practitioners
(1) An agreement may be made between:
(a) an eligible nurse practitioner; and
(b) 1 or more specified medical practitioners.
(2) The agreement must be in writing and signed by the eligible nurse practitioner and the other parties mentioned in paragraph (1)(b).
2H Arrangement—nurse practitioner’s written records
(1) An eligible nurse practitioner must record the following for a patient in the nurse practitioner’s written records:
(a) the name of at least 1 specified medical practitioner who is, or will be, collaborating with the nurse practitioner in the patient’s care (a named medical practitioner);
(b) that the nurse practitioner has told the patient that the nurse practitioner will be providing services to the patient in collaboration with 1 or more specified medical practitioners in accordance with this regulation;
(c) acknowledgement by a named medical practitioner that the practitioner will be collaborating in the patient’s care;
(d) plans for the circumstances in which the nurse practitioner will do any of the following:
(i) consult with a medical practitioner;
(ii) refer the patient to a medical practitioner;
(iii) transfer the patient’s care to a medical practitioner;
(e) any consultation or other communication between the nurse practitioner and a medical practitioner about the patient’s care;
(f) any transfer by the nurse practitioner of the patient’s care to a medical practitioner;
(g) any referral of the patient by the nurse practitioner to a medical practitioner;
(h) if the nurse practitioner gives a copy of a document mentioned in subregulation (2) or (3) to a named medical practitioner—when the copy is given;
(i) if the nurse practitioner gives a copy of a document mentioned in subregulation (4) or (5) to the patient’s usual general practitioner—when the copy is given.
(2) If the nurse practitioner refers the patient to a specialist or consultant physician, or if the nurse practitioner requests diagnostic imaging or pathology services for the patient, the nurse practitioner must give a copy of the referral, or the results of the services, to a named medical practitioner if:
(a) the nurse practitioner:
(i) consults with the named medical practitioner; or
(ii) refers the patient to the named medical practitioner; or
(iii) transfers the patient’s care to the named medical practitioner; and
(b) the named medical practitioner asks the nurse practitioner for a copy of the referral or results.
(3) Also, the nurse practitioner must give a named medical practitioner a record of the services provided by the nurse practitioner to the patient if:
(a) the nurse practitioner:
(i) consults with the named medical practitioner; or
(ii) refers the patient to the named medical practitioner; or
(iii) transfers the patient’s care to the named medical practitioner; and
(b) the named medical practitioner asks the nurse practitioner for the record.
(4) If the nurse practitioner refers the patient to a specialist or consultant physician, or requests diagnostic imaging or pathology services for the patient, and the patient’s usual general practitioner is not a named medical practitioner, the nurse practitioner must give a copy of the referral, or the results of the services, to the patient’s usual general practitioner.
(5) Also, if the patient’s usual general practitioner is not a named medical practitioner, the nurse practitioner must give the patient’s usual general practitioner a record of the services provided by the nurse practitioner to the patient.
(6) However, subregulations (4) and (5) apply only if the patient consents.
3 Professional services
(1) Each medical service described in items 51700 to 53460 of the general medical services table is prescribed for paragraph (b) of the definition of professional service in subsection 3(1) of the Act.
(2) Each professional service described in the following items of the general medical services table is prescribed for subsection 3(18) of the Act:
(a) items 13015 to 16018;
(b) items 16600 to 16636;
(c) items 18213 to 18298
(d) items 20100 to 51318.
3A Health services not specified in an item (Act s 3C)
For paragraph (b) of the definition of health service in subsection 3C(8) of the Act, a service is prescribed if it is a service of a kind mentioned in the following table.
| Item | Service |
| 1 | Aboriginal or Torres Strait Islander health |
| 2 | Audiology |
| 3 | Chiropractic |
| 4 | Diabetes education |
| 5 | Dietetics |
| 6 | Exercise physiology |
| 7 | Focussed psychological strategies |
| 8 | Mental health |
| 8A | Midwifery |
| 9 | Non‑directive pregnancy support counselling |
| 9A | Nurse practitioner services |
| 10 | Occupational therapy |
| 10A | Orthoptic |
| 11 | Osteopathy |
| 12 | Physiotherapy |
| 13 | Podiatry |
| 14 | Psychological therapy |
| 15 | Psychology |
| 16 | Speech pathology |
4 Relevant organisations and qualifications (Act s 3D)
(1) For the definition of relevant organisation in subsection 3D(5) of the Act, the organisation specified in column 2 of an item in Schedule 4 is declared to be a professional organisation in relation to each specialty specified in column 3 of that item.
(2) For the definition of relevant qualification in subsection 3D(5) of the Act, the qualification specified in column 4 of an item in Schedule 4 is declared to be a relevant qualification in relation to the organisation specified in column 2 of that item.
5 Prescribed fee—subsection 3D(1) of the Act
For the purposes of subsection 3D(1) of the Act, the prescribed fee is $30.
6 Prescribed fee—subsection 3E(2) of the Act
For the purposes of subsection 3E(2) of the Act, the prescribed fee is $30.
6A Recognised Fellows of the RACGP
(1) An applicant is eligible for a determination under paragraph 3EA(2)(b) of the Act if the RACGP certifies that the applicant meets the minimum requirements of the RACGP for taking part in continuing medical education and quality assurance.
(2) For subparagraph 3EB(1)(b)(ii) of the Act, a determination under section 3EA of the Act in respect of a medical practitioner must be revoked if the RACGP certifies that the practitioner does not meet the minimum requirements of the RACGP for continuing medical education and quality assurance.
6B Notice to be given of certain decisions
(1) The RACGP must give the Chief Executive Medicare written notice if it declines to certify under subregulation 6A(1).
(2) The Chief Executive Medicare must give a medical practitioner written notice if it receives notice under subregulation (1).
6C Appeals
(1) A medical practitioner who receives notice under:
(a) subregulation 6B(2); or
(b) subsection 3EB(2) of the Act because the RACGP has given the Chief Executive Medicare notice under subparagraph 3EB(1)(b)(ii) of the Act;
may appeal to the Appeal Committee within 28 days after the day the notice is given.
(2) The Appeal Committee must hear and decide the appeal.
(3) If the Committee allows the appeal, the practitioner is eligible for a determination.
(4) If the Committee dismisses the appeal it must give the practitioner written notice with:
(a) the result of the appeal; and
(b) the terms of the decision; and
(c) a statement to the effect that a copy of the reasons for the decision may be obtained from the Committee on written request made within 28 days after the notice is given.
6D Eligibility pending decision on appeal
(1) A medical practitioner remains eligible for a determination if:
(a) the Chief Executive Medicare gives the practitioner notice that a determination under section 3EA of the Act in respect of the practitioner is to be revoked; and
(b) the practitioner’s appeal is received by the Appeal Committee before the date specified in the notice for removal.
(2) The practitioner ceases to be eligible under subregulation (1) when the practitioner’s appeal is finalised.
6DA Recognition of practitioners who meet ACRRM fellowship standards
(1) A medical practitioner may apply to the Chief Executive Medicare for a determination under this regulation.
(2) After receiving an application, the Chief Executive Medicare must, within the required period, determine that the applicant is recognised as meeting the fellowship standards of the ACRRM if the ACRRM gives the Chief Executive Medicare written notice that the applicant is, under regulation 6DB, eligible for a determination.
(3) For subregulation (2), the required period is:
(a) 14 days after the notice was received by the Chief Executive Medicare; or
(b) if the application was made after the notice was received—14 days after the application was received by the Chief Executive Medicare.
(4) The Chief Executive Medicare must give the applicant written notice of the day on which the determination will come into force.
(5) The Chief Executive Medicare may give the ACRRM information about whether or not determinations under this regulation are in force for particular persons.
(6) The Chief Executive Medicare or an authorised officer may make available to members of the public, on request:
(a) the names of medical practitioners for whom determinations under this regulation are in force; and
(b) the addresses at which they practise.
(7) In this regulation:
authorised officer means a Departmental employee (within the meaning given by section 3 of the Human Services (Medicare) Act 1973) authorised in writing by the Chief Executive Medicare for this regulation.
6DB Eligibility for determination
(1) An applicant who attained fellowship of the ACRRM after the requirement to undergo accredited training was first introduced is eligible for a determination only if the applicant:
(a) either:
(i) has successfully completed accredited training; or
(ii) has been assessed by the ACRRM as having training and experience equivalent to successful completion of accredited training; and
(b) meets the minimum requirements that apply to a Fellow of the ACRRM for continuing medical education and quality assurance.
(2) An applicant who attained fellowship of the ACRRM before the requirement to undergo accredited training was first introduced is eligible for a determination only if the applicant:
(a) either:
(i) has been assessed by the ACRRM, using an assessment model approved by the Department, as having training and experience equivalent to successful completion of accredited training; or
(ii) is a vocationally registered general practitioner; and
(b) meets the minimum requirements that apply to a Fellow of the ACRRM for continuing medical education and quality assurance.
(3) In this regulation:
accredited training means a training program and assessments for fellowship of the ACRRM accredited by the Australian Medical Council.
6DC Revocation of determinations
(1) The Chief Executive Medicare must revoke a determination under regulation 6DA about a medical practitioner if:
(a) the medical practitioner requests the Chief Executive Medicare to do so; or
(b) the ACRRM gives the Chief Executive Medicare written notice that the medical practitioner has failed to meet its minimum requirements for continuing medical education and quality assurance; or
(c) the Chief Executive Medicare becomes aware that the medical practitioner is no longer a medical practitioner.
(2) A notice mentioned in paragraph (1)(b) is effective only if, before giving the notice, the ACRRM:
(a) informed the medical practitioner about the proposed notice; and
(b) gave the practitioner at least 14 days to show why the proposed notice should not be given.
(3) Before revoking the determination, the Chief Executive Medicare must give the medical practitioner written notice that the determination is to be revoked.
(4) The notice must specify the day on which the determination is to be revoked.
(5) The day specified under subregulation (4) must not be less than 14 days after the day on which the notice is given.
6E Register of Approved Placements—specified bodies etc
For paragraph 3GA(5)(a) of the Act, the following bodies, courses and programs are specified:
(a) a body mentioned in an item in Part 1 or 2 of Schedule 5;
(b) a course that leads to a qualification in an item in Part 1 of Schedule 5 from the body specified in the item;
(c) a program in an item in Part 2 of Schedule 5 approved by the body specified in the item.
6EA Register of Approved Placements—eligible applicants
For paragraph 3GA(5)(b) of the Act, a medical practitioner who makes application under subsection 3GA(4) of the Act, and to whom subitem 1(2) in Part 3 of Schedule 5 applies, is eligible for registration under section 3GA of the Act.
6EB Register of Approved Placements—removal of name
For paragraph 3GB(1)(c) of the Act, a medical practitioner registered under section 3GA of the Act because of the operation of regulation 6EA must have his or her name removed from the Register of Approved Placements when the earliest of the following events occurs:
(a) a determination under section 3D, 3EA or 61 of the Act, recognising the practitioner’s qualification, takes effect;
(b) the Chief Executive Medicare receives written notice from the appropriate Australian medical college, of its refusal to recognise the practitioner’s qualification;
(c) 12 months elapses since registration of the practitioner under section 3GA of the Act began.
6EF Services for which medicare benefit is 100% of Schedule fee (Act s 10(2)(aa))
For paragraph 10(2)(aa) of the Act, the following services are prescribed:
(a) a service that is:
(i) described in an item of the general medical services table; and
(ii) mentioned in column 3 of Schedule 6;
(b) a service:
(i) that is described in an item of the diagnostic imaging services table; and
(ii) to which clause 1.2.9 or 1.2.10 of Schedule 1 to the diagnostic imaging services table applies.
6F Circumstances in which subparagraphs 19AA(1)(b)(iv) and (2)(b)(iv) of the Act apply
For paragraph 19AA(3)(b) of the Act, subparagraphs 19AA(1)(b)(iv) and (2)(b)(iv) of the Act only apply to a professional service that was rendered by a person, registered under subsection 3GA(5) of the Act, not more than:
(a) 2 weeks after the period for which the person was registered; or
(b) if the Chief Executive Medicare approves—6 weeks after the period for which the person was registered.
6G Interns—relevant State or Territory laws
For subsection 19AA(5) of the Act, the following laws are specified:
(a) Medical Practice Act 1992 of New South Wales;
(b) Medical Practice Act 1994 of Victoria;
(c) Medical Act 1939 of Queensland;
(d) Medical Practitioners Act 1983 of South Australia;
(e) Medical Act 1894 of Western Australia;
(f) Medical Act 1959 of Tasmania;
(g) Medical Practitioners Act 1930 of the Australian Capital Territory;
(h) Northern Territory of Australia Medical Act 1995 of the Northern Territory.
9 Reduction of amounts for purposes of subsection 16(4) of the Act
(1) Where, under paragraph 16(4)(a) of the Act, one amount only shall be deemed to be reduced, that amount shall be deemed to be reduced by 80 per cent.
(2) Where, under paragraph 16(4)(a) of the Act, 2 or more amounts shall be deemed to be reduced, the greater or greatest of those amounts shall be deemed to be reduced by 80 per cent and each other such amount shall be deemed to be reduced by 90 per cent.
(3) For the purposes of subregulation (2), where 2 or more of the amounts that shall be deemed to be reduced are equal, one of those amounts shall be treated as being greater than the other amount or the greatest of those amounts.
9A Requests for pathology services by electronic means
(1) For section 16A of the Act, subregulation (2) applies if:
(a) a request for a pathology service is made or confirmed by electronic means; and
(b) a practitioner, participating midwife or participating nurse practitioner is identified as the person who made the request or confirmation:
(i) by name, number or other means in the request or confirmation; or
(ii) by the electronic system used to make the request or confirmation.
(2) The request or confirmation is taken to have been made by the person unless the person shows that he or she did not make the request or confirmation.
10 Diagnostic imaging services which dental practitioners may request
(1) For subsection 16B(2) of the Act, a service of each of the following kinds is specified:
(a) if the dental practitioner who requests the service is approved by the Minister under paragraph (b) of the definition of professional service in subsection 3(1) of the Act—a service described in any of items 55005, 55008, 55011, 55028, 55030, 55032, 56001 to 56220, 56224, 56227, 56230, 56259, 56301 to 56507, 56541, 56547, 56801 to 57007, 57041, 57047, 57341, 57345, 57703, 57705, 57709, 57711, 57712, 57714, 57715, 57717, 58103 to 58115, 58117, 58123, 58124, 58306, 58308, 58506, 58508, 58521 to 58527, 58529, 58909, 58911, 59103, 59104, 59703, 59704, 60000 to 60010, 60506, 60507, 60509, 60510, 61109, 61110, 61372, 61421, 61425, 61429, 61430, 61433, 61434, 61446, 61449, 61450, 61453, 61454, 61457, 61462, 61672, 61690, 61691, 61693, 61694, 61695, 61696, 61702, 61703, 61704, 61705, 61706, 61707, 61710, 63007, 63016, 63334 and 63346;
(b) if the dental practitioner who requests the service is a prosthodontist—a service described in any of items 55005, 55028, 56013, 56016, 56022, 56028, 56053, 56056, 56062, 56068, 57362, 57363, 58306, 58308, 61421, 61425, 61429, 61430, 61433, 61434, 61446, 61449, 61450, 61453, 61454, 61457, 61462, 61690, 61691, 61693, 61694, 61695, 61696, 61702, 61703, 61704, 61705, 61706, 61707, 61710, 63334 and 63346;
(c) if the dental practitioner who requests the service is a dental specialist—a service described in any of items 56022, 56062, 57362, 57363, 58306, 58308, 61421, 61454, 61457, 61690, 61706, 61707, 63334 and 63346;
(d) if the dental practitioner who requests the service is an oral medicine specialist or oral pathology specialist—a service described in any of items 55005, 55008, 55011, 55028, 55030, 55032, 56001, 56007, 56010, 56013, 56016, 56022, 56028, 56041, 56047, 56050, 56053, 56056, 56062, 56068, 56101, 56107, 56141, 56147, 56301, 56307, 56341, 56347, 56401, 56407, 56441, 56447, 57341, 57345, 57362, 57363, 58306, 58308, 58506, 58508, 58909, 58911, 59103, 59104, 59703, 59704, 60000 to 60010, 60506, 60507, 60509, 60510, 61109, 61110, 61372, 61421, 61425, 61429, 61430, 61433, 61434, 61446, 61449, 61450, 61453, 61454, 61457, 61462, 61672, 61690, 61691, 61693, 61694, 61695, 61696, 61702, 61703, 61704, 61705, 61706, 61707, 61710, 63007, 63016, 63334 and 63346;
(e) in any case—a service described in any of items 57509, 57515, 57521, 57527, 57530, 57533, 57536, 57539, 57901 to 57969, 58100, 58102, 58300, 58302, 58503, 58505, 58903, 58905, 59733, 59734, 59739, 59740, 59751, 59752, 60100, 60101, 60500, 60501, 60503 and 60504.
(2) In paragraph (1)(b), prosthodontist means a person who is:
(a) registered or licensed as a prosthodontist under a law of a State or Territory; or
(b) registered or licensed as a dentist or dental practitioner under a law of a State or Territory and recognised by the registering or licensing authority as a person who practises in the specialty of prosthodontics.
(3) In paragraph (1)(c), dental specialist means a person who is:
(a) registered or licensed as a periodontist, endodontist, pedeodontist, or orthodontist under a law of a State or Territory; or
(b) registered or licensed as a dental specialist under a law of a State or Territory and recognised by the registering or licensing authority as a person who practices in the speciality of periodontics, endodontics, pedeodontics, or orthodontics.
(4) In paragraph (1)(d):
oral medicine specialist means a person who is:
(a) registered or licensed as an oral medicine specialist under a law of a State or Territory; or
(b) registered or licensed as a dental specialist under a law of a State or Territory and recognised by the registering or licensing authority as a person who practices in the speciality of oral medicine.
oral pathology specialist means a person who is:
(a) registered or licensed as an oral pathology specialist under a law of a State or Territory; or
(b) registered or licensed as a dental specialist under a law of a State or Territory and recognised by the registering or licensing authority as a person who practices in the speciality of oral pathology.
11 Diagnostic imaging services that chiropractors, osteopaths, physiotherapists and podiatrists may request
(1) For subsection 16B(3), (3A) or (3C) of the Act, the services are those mentioned in the diagnostic imaging services table in items 57712, 57714, 57715, 57717, 58100 to 58106, 58109, 58111, 58112, 58117, 58120, 58121, 58123, 58126 and 58127.
(2) For subsection 16B(3B) of the Act, the services are those mentioned in the diagnostic imaging services table in items 55836, 55837, 55840, 55841, 55844, 55845, 57521, 57527, 57536 and 57539.
11A Pathology services determined to be necessary by participating midwives and participating nurse practitioners
(1) For subparagraph 16A(1)(aa)(ii) of the Act, the services in relation to a participating midwife are those mentioned in the pathology services table in items 65060, 65070, 65090 to 65099 (inclusive), 65114, 66500 to 66512 (inclusive), 66545, 66548, 66566, 66743, 66750, 66751, 69303 to 69317 (inclusive), 69324, 69384 to 69415 (inclusive), 73053 and 73529.
(2) For subparagraph 16A(1)(ab)(ii) of the Act, the services in relation to a participating nurse practitioner are those mentioned in the pathology services table in items 65060 to 73810 (inclusive).
11B Diagnostic imaging services that participating midwives and participating nurse practitioners may request
(1) For subsection 16B(3D) of the Act, the services in relation to a participating midwife are those mentioned in the diagnostic imaging services table in items 55700, 55701, 55704, 55706, 55707, 55710, 55713, 55714, 55718 and 55722.
(2) For subsection 16B(3E) of the Act, the services in relation to a participating nurse practitioner are those mentioned in the diagnostic imaging services table in items 55014, 55036, 55059, 55061, 55070, 55076, 55600, 55601, 55769, 55800, 55801, 55804, 55805, 55808, 55809, 55812, 55813, 55816, 55817, 55820, 55821, 55824, 55825, 55828, 55829, 55832, 55833, 55836, 55837, 55840, 55841, 55844, 55845, 55848, 55849, 55850, 55851, 55852, 55853, 57509, 57515, 57521, 57530, 57533, 57536, 58503 to 58527 and 58529.
12 Exemption—pre‑existing diagnostic imaging services
For subsection 16B(11) of the Act, the services are those mentioned in the diagnostic imaging services table in items 57712, 57714, 57715, 57717, 57901, 57902, 57903, 57911, 57912, 57914, 57915, 57917, 57921, 57926, 57929, 57935, 58100 to 58115, 58117, 58123, 58124, 58521, 58523, 58524, 58526, 58527, 58529, 58700, 58702, 58924 58926, 59103 and 59104.
12A Prescribed date—paragraph 16B(11)(d) of the Act
For paragraph 16B(11)(d) of the Act, the prescribed date is 1 January 2001.
12B Definition of radiation oncology service
For subsection 16F(2) of the Act, a radiation oncology service is a service to which an item in subgroup 3, 4 or 5 of Group T2 in the general medical services table relates.
13 Particulars to be recorded on accounts, receipts and bulk billing agreement
(1) For the purposes of subsection 19(6) of the Act, the following particulars are prescribed in relation to professional services generally:
(a) the name of the patient to whom the service was given;
(b) the date on which the service was given;
(c) the amount charged in respect of the service;
(d) the total amount paid in respect of the service;
(e) any amount outstanding in respect of the service.
(1A) For the purposes of subsection 19(6) of the Act, the following particulars are prescribed in relation to professional services rendered by a person who has been determined to be a medical practitioner under subsection 3J(1) of the Act:
(a) the name and the address of the medical practitioner;
(b) the provider number of the medical practitioner.
(1B) For the purposes of subsection 19(6) of the Act, the particulars prescribed in relation to professional services rendered by a medical practitioner other than a medical practitioner referred to in subregulation (1A) are:
(a) the name and the address of the medical practitioner; and
(b) the provider number of the medical practitioner;
either or both of which may be given.
(1C) For subsection 19(6) of the Act, either or both of the following particulars are prescribed for professional services provided by a participating midwife or participating nurse practitioner:
(a) the name and address of the participating midwife or participating nurse practitioner;
(b) the provider number of the participating midwife or participating nurse practitioner.
(2) For subsection 19(6) of the Act, the following particulars are prescribed in relation to professional services rendered as part of an episode of hospital treatment:
(a) a description of the professional service and the item number of the item that relates to the professional service, followed by an asterisk; or
(b) a description of the professional service sufficient to identify the item that relates to the professional service, preceded by the word ‘patient’.
(2A) For subsection 19(6) of the Act, if professional services are rendered as part of an episode of hospital‑substitute treatment and the person who receives the treatment chooses to receive a benefit from a private health insurer, the following particulars are prescribed for those services:
(a) a description of the professional service and the item number of the item that relates to the professional service, followed by the words ‘hospital‑substitute treatment’; or
(b) a description of the professional service sufficient to identify the item that relates to the professional service, preceded by the words ‘hospital‑substitute treatment’.
(3) For the purposes of subsection 19(6) of the Act, the following particular is prescribed in relation to professional services other than professional services referred to in subregulation (2), namely, a description of the professional service sufficient to identify the item that relates to the service.
(4) For the purposes of subsection 19(6) of the Act, the following particulars are prescribed in relation to professional services rendered by a consultant physician, or a specialist, in the practice of his or her specialty to a patient who was referred to that consultant physician or specialist in the manner prescribed in regulation 29 by a referring practitioner:
(a) the name of the referring practitioner;
(b) the address of the place of practice, or the provider number in respect of the place of practice, of the referring practitioner;
(c) the date on which the patient was referred by the referring practitioner to the consultant physician or specialist;
(d) the period of validity of the referral applicable under regulation 31.
(5) For the purposes of subsection 19(6) of the Act, if a referral is given under subregulation 30(1) the words, ‘referral within (insert the name of the hospital in which the referral was given)’ are prescribed.
(6) For the purposes of subsection 19(6) of the Act, the following particulars are prescribed in relation to professional services rendered by a consultant physician, or a specialist, in the practice of his or her specialty to a patient who has declared to the consultant physician or specialist that a referral referring the patient to that consultant physician or specialist has been completed by a referring practitioner, the name of the referring practitioner, and that the referral has not been delivered to the consultant physician or specialist due to the referral having been lost, stolen or destroyed:
(a) the name of the referring practitioner;
(b) the words ‘lost referral’;
(c) the address of the place of practice, or the provider number in respect of the place of practice, of the referring practitioner (if either of these are known to the consultant physician or specialist).
(7) For the purposes of subsection 19(6) of the Act, the word ‘emergency’ is prescribed if:
(a) a referring practitioner; or
(b) a specialist or consultant physician in the practice of his or her speciality;
decides in an emergency that it is necessary in the patient’s interests for a professional service to be given as soon as practicable.
(8) For the purposes of subsection 19(6) of the Act, the following particular is prescribed in relation to professional services to which an item in items 3 to 10929 (inclusive) of the general medical services table relates, namely, where a practitioner or optometrist was in attendance on a person on more than one occasion on the same day and on each occasion rendered such a professional service on that person, the time at which each such attendance on that day commenced.
(8A) For subsection 19(6) of the Act, subregulation (8B) applies if a participating midwife or participating nurse practitioner:
(a) attends a person more than once on the same day; and
(b) on each occasion provides a professional service to the person.
(8B) The time each attendance starts is prescribed as a particular for the participating midwife or participating nurse practitioner.
(9) For the purposes of subsection 19(6) of the Act, the following particulars are prescribed in relation to professional services to which an item in the pathology services table relates:
(a) where the professional service is a pathology service in respect of which the payment of a medicare benefit is not prevented by the operation of subsection 16A(1), (2) or (3) of the Act:
(i) the name and:
(A) where the request referred to in subsection 16A(3) of the Act in respect of which the professional service was rendered was made at the place of practice of the practitioner, participating midwife or participating nurse practitioner who determined that the professional service was necessary—the provider number in respect of that place of practice of that practitioner, participating midwife or participating nurse practitioner; or
(B) where that request was not made at the place of practice of the practitioner, participating midwife or participating nurse practitioner who determined that the professional service was necessary—the provider number in respect of any place of practice of that practitioner, participating midwife or participating nurse practitioner; and
(ii) the date on which the practitioner, participating midwife or participating nurse practitioner so determined that the service was necessary;
(b) where the professional service is a pathologist‑ determinable service that was determined to be necessary by the approved pathology practitioner by whom, or on whose behalf, the service was performed—the initials ‘s.d.’ or ‘p.d.’;
(c) where the professional service is a pathology service to which subsection 16A(7) of the Act applies—if the service was rendered in pursuance of a request of the kind referred to in paragraph 16A(7)(b) of the Act—the date on which the request referred to in that subparagraph was made and the surname, and the initials of the Christian or given names, of the medical practitioner who determined that the service was necessary or, where at least one other member of the group of practitioners of which he is a member has the same surname and the same initials as the medical practitioner, the surname, and such of the Christian or given names, of the medical practitioner as distinguish him from each of those other members.
(10) For subsection 19(6) of the Act, if the professional service rendered is the collection of a specimen and is the initiation of a patient episode, there is to be recorded, for that pathology service, the appropriate collection point identification number as follows:
(a) for a collection made at an approved collection centre, the approved pathology collection centre identification number assigned by the Chief Executive Medicare to that collection centre;
(b) for a collection made at a recognised hospital, the recognised hospital collection point identification number assigned by the Chief Executive Medicare to that hospital;
(d) for a collection made at a location not described in paragraph (a) or (b), the collection point identification number ‘A01’.
(10A) An identification number mentioned in paragraph (10)(a) (an approved pathology collection centre identification number) is valid only in relation to a collection made at an approved collection centre by the Approved Pathology Authority that is the owner of that collection centre.
(11) For the purposes of subsection 19(6) of the Act, the following particulars are prescribed in relation to professional services to which any of items 12500 to 12533 (inclusive), 15000 to 15600 (inclusive) and 16003 to 16015 (inclusive) of the general medical services table or an item in the diagnostic imaging services table relates:
(a) if the professional service is provided by a specialist in diagnostic radiology—the name and either the address of the place of practice, or the provider number, of that specialist; or
(b) if the professional service is provided by a practitioner other than a specialist in diagnostic radiology—the name and either the address of the place of practice, or the provider number in respect of the place of practice, of the practitioner who:
(i) is claiming, or receiving, payment of fees in respect of the professional service; or
(ii) is the assignee of the right to the payment of that benefit under an assignment or agreement made in accordance with section 20A of the Act, in relation to the medicare benefit in respect of the professional service, if an assignment of that kind has been made, or an agreement of that kind entered into.
(12) For subsection 19(6) of the Act, particulars for professional services to which an item in the pathology services table, other than items 73801 to 73811 (inclusive), relates are the name and either the address of the place of practice or the provider number for the place of practice of:
(a) the approved pathology practitioner by whom, or on whose behalf, the professional service was rendered; or
(b) if the professional service was rendered completely in an accredited pathology laboratory—any approved pathology practitioner rendering professional services in the accredited pathology laboratory; or
(c) any approved pathology practitioner rendering professional services in an accredited pathology laboratory that is owned and controlled by an approved pathology authority if:
(i) a request for the professional service was received by:
(A) any approved pathology practitioner rendering professional services in the accredited pathology laboratory; or
(B) the approved pathology authority; and
(ii) the professional service was rendered partly in the accredited pathology laboratory and partly in another accredited pathology laboratory that are both owned and controlled by the approved pathology authority.
(13) For subsection 19(6) of the Act, the following particulars are prescribed for professional services other than those mentioned in subregulation (13A):
(a) the name of the practitioner, optometrist, participating midwife or participating nurse practitioner who provided the professional service;
(b) a statement that the professional service was provided by that person;
(c) either:
(i) the address of the place of practice where the service was provided; or
(ii) both:
(A) if the service was provided at a place of practice for which that person has been allocated a provider number—the provider number; and
(B) in any other case—the provider number allocated to that person for any place where he or she practices.
(13A) Subregulation (13) does not apply to a professional service to which any of the following items relate:
(a) an item in the pathology services table other than items 73801 to 73811 (inclusive);
(b) any of items 12500 to 12533 (inclusive), 15000 to 15600 (inclusive) and 16003 to 16015 (inclusive) of the general medical services table;
(c) an item in the diagnostic imaging services table.
(14) Subject to subregulations (15) and (16), the following particulars are prescribed for the purposes of subsection 19(6) of the Act in relation to professional services to which an item in the diagnostic imaging services table relates:
(a) the name and either:
(i) the address of the place of practice; or
(ii) the provider number in respect of the place of practice;
of the person who requested that professional service;
(b) the date on which that professional service was requested;
(c) the name and either:
(i) the address of the place of practice; or
(ii) the provider number in respect of the place of practice;
of the practitioner who:
(iii) is claiming, or receiving, payment of fees in respect of that professional service; or
(iv) if an assignment has been made, or an agreement entered into, in accordance with section 20A of the Act, in relation to the medicare benefit in respect of that professional service, is the assignee of the right to the payment of that benefit under that assignment or agreement.
(15) If the person referred to in paragraph (14)(a) is a chiropractor, osteopath, physiotherapist or podiatrist, the reference in subparagraph (14)(a)(ii) to a provider number is a reference to a requester number.
(16) For the purposes of subsection 19(6) of the Act, if the practitioner referred to in paragraph (14)(c) is not the practitioner who rendered the professional service referred to in subregulation (14), the following additional particulars are prescribed in relation to that professional service, namely the name and either:
(a) the address of the place of practice; or
(b) the provider number in respect of the place of practice;
of the second‑mentioned practitioner, unless those particulars and the date on which the professional service was requested are recorded at the place of practice of the first‑mentioned practitioner.
(17) For the purposes of subsection 19(6) of the Act, if professional services to which an item in the diagnostic imaging services table relates are rendered:
(a) by a consultant physician or a specialist in circumstances specified in subsection 16B(6) of the Act; or
(b) within an area that is a remote area for the purposes of Division 2 of Part IIB of the Act in circumstances specified in subsection 16B(7) of the Act; or
(c) as an additional necessary service in circumstances specified in subsection 16B (10) of the Act; or
(d) in circumstances specified in subsection 16B(11) of the Act;
the following particular is prescribed in relation to those services—the letters ‘SD’, indicating that the services were self‑determined.
(17A) For subsection 19(6) of the Act, if professional services to which an item in the diagnostic imaging services table relates are rendered in the circumstances mentioned in subsection 16B(10A) of the Act, the letters ‘SS’ (indicating that the services were substituted for a requested service) are a prescribed particular in relation to those services.
(18) For the purposes of subsection 19(6) of the Act, if professional services to which an item in the diagnostic imaging services table relates are rendered in circumstances specified in subsection 16B(8) of the Act, the following particular is prescribed in relation to those services—the word ‘emergency’.
(19) For the purposes of subsection 19(6) of the Act, if professional services to which an item in the diagnostic imaging services table relates are rendered in circumstances specified in subsection 16B(9) of the Act, the following particular is prescribed in relation to those services—the words ‘lost request’.
(20) For subsection 19(6) of the Act, the following additional particulars are prescribed in relation to professional services to which any of items 23010 to 24136 of the general medical services table relates:
(a) if the service rendered is administration of anaesthesia (other than administration of anaesthesia performed in association with a service to which item 22900 or 22905 applies):
(i) the name of each practitioner who performed a procedure for which the anaesthesia was administered; and
(ii) if item 25025 applies to the service—when the service time began and ended, and the duration of the service time; and
(b) if the service rendered is perfusion to which item 25050 applies—when the service time began and ended, and the duration of the service time; and
(c) if the service rendered is assistance in the administration of anaesthesia:
(i) the name of the principal anaesthetist; and
(ii) the name of each practitioner who performed a procedure for which the anaesthesia was administered; and
(iii) if item 25030 applies to the service—when the service time began and ended, and the duration of the service time.
(21) In subregulation (20):
service time has the meaning given by clause 2.43.4 in Part 2 of the general medical services table.
(22) For subsection 19(6) of the Act, in relation to professional services consisting of:
(a) diagnostic imaging services rendered using a diagnostic imaging procedure carried out using diagnostic imaging equipment ordinarily located at registered diagnostic imaging premises or, when not in use, at a registered base for diagnostic imaging equipment; or
(b) radiation oncology services rendered using radiation oncology equipment ordinarily located at registered radiation oncology premises or, when not in use, at a registered base for radiation oncology equipment;
the location specific practice number for the premises or base is a prescribed particular.
13AA Payment to general practitioner by electronic transmission (Act s 20(5))
(1) This regulation applies to the payment, by the Chief Executive Medicare on behalf of the Commonwealth, of an amount under subsection 20(3) of the Act to a general practitioner by whom, or on whose behalf, a professional service was rendered.
(2) For subsection 20(5) of the Act, the amount may be paid by electronic transmission if the claim for medicare benefit for the service:
(a) is made using any of the following electronic claiming channels:
(i) Medicare Online;
(ii) Medicare Easyclaim;
(iii) ECLIPSE; or
(b) is made by, or on behalf of, a general practitioner who:
(i) is enrolled, for the location at which the professional service was rendered, in the scheme known as the ‘90 Day Pay Doctor Cheque Scheme’ administered by the Chief Executive Medicare for the purpose of making payments by electronic transmission of amounts to general practitioners under subsection 20(3) of the Act; and
(ii) has given the Chief Executive Medicare written permission to give to the Reserve Bank of Australia the following information:
(A) the name and number of the account into which a payment to the general practitioner under subsection 20(3) of the Act may be made;
(B) the name and BSB number of the bank at which that account is kept.
(3) For the purposes of section 20 of the Act:
general practitioner includes a medical practitioner (other than a specialist or consultant physician) who practises in general practice.
13AB Payment to specialists or consultant physicians by electronic transmission (Act s 20(5))
(1) This regulation applies to the payment, by the Chief Executive Medicare on behalf of the Commonwealth, of an amount under subsection 20(3) of the Act to a specialist or consultant physician by whom, or on whose behalf, a professional service was rendered.
(2) For subsection 20(5) of the Act, the amount may be paid by electronic transmission if the claim for medicare benefit for the service is made using any of the following electronic claiming channels:
(a) Medicare Online;
(b) Medicare Easyclaim;
(c) ECLIPSE.
13AC Manner of electronic claim (Act s 20(6))
For subsection 20(6) of the Act, the claim must be made using an electronic claiming channel mentioned in subregulation 13AB(2).
13B Application for approval as billing agent
(1) For paragraph 20AB(2)(a) of the Act, an application must be in the form approved by the Chief Executive Medicare.
(2) For paragraph 20AB(2)(b) of the Act, the fee to accompany an application is:
(a) if the applicant has not previously been approved as a billing agent—$1,000; or
(b) in any other case—$500.
14 Medicare benefit not payable in respect of certain professional services
(1) Unless the Minister otherwise directs, medicare benefits are not payable in respect of professional services rendered in prescribed circumstances.
(2) Each of the following shall be taken to be professional services rendered in prescribed circumstances:
(a) professional services rendered in relation to the provision of chelation therapy (that is to say, the intravenous administration of ethylenediamine tetra‑acetic acid or any of its salts) otherwise than for the treatment of heavy‑metal poisoning;
(b) professional services rendered in association with the injection of human chorionic gonadotrophin in the management of obesity;
(c) professional services rendered in relation to the use of hyperbaric oxygen therapy in the treatment of multiple sclerosis;
(e) professional services rendered for the purpose of, or in relation to, the removal of tattoos;
(ea) professional services rendered for the purposes of, or in relation to, the removal from a cadaver of kidneys for transplantation;
(f) professional services rendered for the purposes of, or in relation to:
(i) the transplantation of a thoracic or abdominal organ, other than a kidney, or of part of an organ of that kind; or
(ii) the transplantation of a kidney in conjunction with the transplantation of a thoracic or other abdominal organ, or of a part of an organ of that kind;
if the services are rendered to a patient of a hospital;
(g) professional services rendered for the purpose of administering microwave (UHF radiowave) cancer therapy, including the intravenous injection of drugs used immediately before or during the therapy.
14A Eligibility requirements for midwives
For paragraph 21(1)(b) of the Act, a midwife must meet any registration standard for an eligible midwife developed by the Nursing and Midwifery Board for subsection 38(2) of the National Law.
Note: Subsection 38(2) of the National Law deals with developing registration standards about matters for health practitioners.
15 Service of notice under subsection 23B(6) of the Act
For the purposes of subsection 23B(6) of the Act, a notice of termination shall be served by being delivered personally or by pre‑paid post to:
(a) where the premises to which the notice relates are situated in a State—the Director of Health, in that State;
(b) where the premises to which the notice relates are situated in the Australian Capital Territory—the Director of Health, in the State of New South Wales; or
(c) where the premises to which the notice relates are situated in the Northern Territory—the Director of Health, in the State of South Australia.
16 Application for acceptance of undertaking—repayment of fee
For the purposes of section 23DJ of the Act, the fee paid by a person who gives an undertaking under subsection 23DC(1) or 23DF(1) of the Act shall be repaid to the person, where the undertaking is not accepted, by forwarding an amount equal to the amount of the fee to the person at the address specified in the application for the Minister’s acceptance of the undertaking or at such other address as the person specifies by notice in writing to the Minister.
16A Records of pathology services to be kept by approved pathology authorities
(1) For the purposes of subsection 23DKA(1) of the Act, an approved pathology authority must prepare and maintain, in accordance with subregulations (2) and (3), records of the pathology services rendered in an accredited pathology laboratory of which the authority is the proprietor.
(2) For each service rendered, the record in relation to the service must include a copy of a report of the service.
(3) The records must be kept in a manner that enables information to be retrieved from the records on the basis of:
(a) the name of the person to whom the service was rendered; and
(b) the date on which the service was rendered.
17 Application for approval of premises—prescribed fees
For the purposes of paragraph 23DN(1)(b) of the Act, the prescribed fee in relation to an application for the approval of premises as an accredited pathology laboratory is:
(a) where the premises are accredited as a pathology laboratory under the Pathology Laboratories Accreditation Act, 1981 of the State of New South Wales or are an accredited pathology service under the Pathology Services Accreditation Act 1984 of the State of Victoria—$50; or
(b) in any other case—$200.
18 Application for approval of premises—repayment of fees
For the purposes of subsection 23DN(8) of the Act, the fee paid by a person who makes an application under subsection 23DN(1) of the Act shall be repaid to the person, where the application is not granted, by forwarding an amount equal to the amount of the fee to the person at the address specified in the application or at such other address as the person specifies by notice in writing to the Minister.
18A Branded Pathology Request Form
(1) For subsection 23DP(3) of the Act, a pathology request form that is a branded pathology request form must include one of the following statements:
(a) ‘Your doctor has recommended that you use [insert name of pathology provider]. You are free to choose your own pathology provider. However, if your doctor has specified a particular pathologist on clinical grounds, a Medicare rebate will only be payable if that pathologist performs the service. You should discuss this with your doctor.’;
(b) ‘Your treating practitioner has recommended that you use [insert name of pathology provider]. You are free to choose your own pathology provider. However, if your treating practitioner has specified a particular pathologist on clinical grounds, a Medicare rebate will only be payable if that pathologist performs the service. You should discuss this with your treating practitioner.’.
(2) In this regulation:
branded pathology request form means a pathology request form that:
(a) if the form is provided by an approved pathology authority—includes:
(i) the registered name or trading name of the approved pathology authority; and
(ii) the location of one or more specimen collection centres; and
(b) if the form is provided by an approved pathology practitioner—includes:
(i) the registered name or trading name of an approved pathology authority that employs or engages the approved pathology practitioner; and
(ii) the location of one or more specimen collection centres.
19 Information that must be included in requests for diagnostic imaging services
(1) For the purposes of subsection 23DQ(1) of the Act, the following information must be included in a subsection 16B(1) request:
(a) the name and either:
(i) the address of the place of practice; or
(ii) the provider number in respect of the place of practice;
of the requesting practitioner;
(b) the date of the request;
(c) a description of the diagnostic imaging service;
(d) if all of the following circumstances apply—a statement that informs the patient that the request may be taken to a diagnostic imaging provider of the patient’s choice:
(i) the request is made on a document for use by requesting practitioners in making subsection 16B(1) requests; and
(ii) the document is supplied, or made available to, a requesting practitioner by a diagnostic imaging provider on or after 1 August 2012; and
(iii) the document contains relevant information about the diagnostic imaging provider at the time the document is supplied or made available.
(2) For the purposes of subregulation (1), a description of the diagnostic imaging service must provide, in terms that are generally understood throughout the medical profession, sufficient information to identify the item of the diagnostic imaging services table that relates to the service but it need not specify the item number.
(3) In this regulation:
diagnostic imaging provider means a person who:
(a) renders diagnostic imaging services; or
(b) carries on the business of rendering diagnostic imaging services; or
(c) employs, or engages under a contract of service, a person mentioned in paragraph (a) or (b).
relevant information means:
(a) the registered name or trading name of the diagnostic imaging provider; and
(b) one or more locations of the diagnostic imaging provider if diagnostic imaging services are rendered at the location.
20 Records of diagnostic imaging services that must be kept by providing medical practitioners
(1) For the purposes of subsection 23DS(1) of the Act, a medical practitioner who provides diagnostic imaging services (in this regulation called the providing practitioner) must prepare and maintain records of those services.
(2) For each service rendered, the providing practitioner’s records must include:
(a) a copy of the report by the providing practitioner; and
(b) if the service is rendered in circumstances specified in subsection 16B(8) of the Act, sufficient information to indicate the nature of the emergency; and
(c) if the service is rendered in circumstances specified in subsection 16B(9) of the Act, words indicating:
(i) that the person to whom the service was rendered, or a person acting on that person’s behalf, asserted that a medical practitioner, a dental practitioner, a chiropractor, an osteopath, a physiotherapist, a podiatrist, a participating midwife or a participating nurse practitioner (in this regulation called the requesting practitioner) had requested that the service be rendered but that the request had been lost; and
(ii) that the providing practitioner, or an employee or agent of the providing practitioner, had sought and received from the requesting practitioner, or from an employee or agent of the requesting practitioner, confirmation that the request had been made; and
(iii) the date and manner of that confirmation; and
(d) if the service is rendered in the circumstances mentioned in subsection 16B(10A) of the Act:
(i) words indicating that the providing practitioner has consulted with the requesting practitioner and the date of that consultation; or
(ii) if the providing practitioner has not consulted with the requesting practitioner, sufficient information to demonstrate that he or she has taken all reasonable steps to do so.
(2A) If an ultrasound service is performed by a registered sonographer under the supervision, or at the direction, of the providing practitioner, the report mentioned in paragraph (2)(a) must include the name of the registered sonographer who performed the service.
(3) The providing practitioner’s records must be kept in a manner that enables retrieval of information on the basis of:
(a) the name of the person to whom the service was rendered; and
(b) the date on which the service was rendered.
(4) In this regulation:
registered sonographer means a person whose name is entered on the Register of Sonographers kept by the Chief Executive Medicare.
20A Diagnostic imaging—information to be included in application for registration
For paragraph 23DZP(1)(d) of the Act, the other information to be included in an application for registration of diagnostic imaging premises or a base for mobile diagnostic imaging equipment is:
(a) the nature of the practice; and
(b) details of the diagnostic imaging equipment ordinarily located at the premises or base, including:
(i) if the equipment is a type of equipment, prescribed in regulation 20C—the type of equipment, the age and quantity of equipment of that type; and
(iii) the functionality of the equipment; and
(iv) if the equipment has a serial number or other identifying number—that number; and
(c) if the premises are, or the base is, accredited under a diagnostic imaging accreditation scheme—the information mentioned in subregulation 20B(2).
Example for paragraph (a): The practice might be a base for mobile equipment, a specialist diagnostic imaging practice (either on a stand‑alone practice site or co‑located with a primary care practice or group), a primary care practice, a sports medicine clinic or a public hospital.
20B Diagnostic imaging—information to be included on register
(1) For subparagraph 23DZQ(1)(b)(iv) of the Act, the other information to be included on the register is the information included in the application for registration.
(2) For subsections 23DZZIAB(1) and (2) of the Act, the following information is to be included on the register:
(a) the name of the approved accreditor;
(b) the commencement date for the accreditation;
(c) the diagnostic imaging procedures for which the premises are, or base is, accredited or not accredited;
(d) the expiry date for the accreditation.
20C Primary information—types of diagnostic imaging equipment
(1) For subsection 23DZR(2) of the Act, diagnostic imaging equipment is prescribed if:
(a) the equipment is used in carrying out a diagnostic imaging procedure used in rendering a service that is described in an item of the type mentioned in columns 2 and 3 of an item of the following table; and
(b) the conditions (if any) mentioned in column 4 of that item of the following table are met.
| Diagnostic imaging equipment |
| Item | Column 1 Diagnostic imaging equipment | Column 2 The item is … | Column 3 in the following provision of the diagnostic imaging services table: | Column 4 Conditions |
| 1 | Ultrasound equipment non‑musculoskeletal K‑type | a (K) item | Group I1 (other than Subgroup 6) | The equipment: (a) does not include a transducer capable of operating at a frequency of 7.5 megahertz or higher; and (b) is 10 years old or less |
| 2 | Ultrasound equipment non‑musculoskeletal K‑type upgraded | a (K) item | Group I1 (other than Subgroup 6) | The equipment: (a) does not include a transducer capable of operating at a frequency of 7.5 megahertz or higher; and (b) is more than 10 years old and no more than 15 years old; and (c) was upgraded on or before it was 10 years old |
| 3 | Ultrasound equipment non‑musculoskeletal NK‑type | an (NK) item | Group I1 (other than Subgroup 6) | The equipment: (a) does not include a transducer capable of operating at a frequency of 7.5 megahertz of higher; and (b) either: (i) is more than 10 years old and has not been upgraded; or (ii) was upgraded on or before it was 10 years old and is more than 15 years old |
| 4 | Ultrasound equipment musculoskeletal K‑type | a (K) item | Subgroup 6 of Group I1 | The equipment: (a) includes a transducer capable of operating at a frequency of 7.5 megahertz or higher; and (b) is 10 years old or less |
| 5 | Ultrasound equipment musculoskeletal K‑type upgraded | a (K) item | Subgroup 6 of Group I1 | The equipment: (a) includes a transducer capable of operating at a frequency of 7.5 megahertz or higher; and (b) is more than 10 years old and no more than 15 years old; and (c) was upgraded on or before it was 10 years old |
| 6 | Ultrasound equipment musculoskeletal NK‑type | an (NK) item | Subgroup 6 of Group I1 | The equipment: (a) includes a transducer capable of operating at a frequency of 7.5 megahertz or higher; and (b) either: (i) is more than 10 years old and has not been upgraded; or (ii) was upgraded on or before it was 10 years old and is more than 15 years old |
| 6A | Computed tomography equipment K‑type | a (K) item | Group I2 | The equipment is 10 years old or less |
| 7 | Computed tomography equipment K‑type upgraded | a (K) item | Group I2 | The equipment: (a) is more than 10 years old and no more than 15 years old; and (b) was upgraded on or before it was 10 years old or before 1 January 2016 |
| 8 | Computed tomography equipment NK‑type | an (NK) item | Group I2 | The equipment: (a) is more than 10 years old and has not been upgraded; or (b) was upgraded on or before it was 10 years old or before 1 January 2016, and is more than 15 years old |
| 9 | Magnetic resonance imaging equipment K‑type | a (K) item | Group I5 | The equipment is 10 years old or less |
| 10 | Magnetic resonance imaging equipment K‑type upgraded | a (K) item | Group I5 | The equipment: (a) is more than 10 years old and no more than 20 years old; and (b) was upgraded on or before it was 10 years old |
| 11 | Magnetic resonance imaging equipment NK‑type | an (NK) item | Group I5 | The equipment: (a) is more than 10 years old and has not been upgraded; or (b) was upgraded on or before it was 10 years old and is more than 20 years old |
| 12 | Nuclear medicine imaging equipment for positron emission tomography | any of items 61523 to 61646 | Group I4 | |
| 13 | Nuclear medicine imaging equipment K‑type | a (K) item | Group I4 (other than items 61523 to 61646) | The equipment is 10 years old or less |
| 14 | Nuclear medicine imaging equipment K‑type upgraded | a (K) item | Group I4 (other than items 61523 to 61646) | The equipment: (a) is more than 10 years old and no more than 15 years old; and (b) was upgraded on or before it was 10 years old |
| 15 | Nuclear medicine imaging equipment NK‑type | an (NK) item | Group I4 | The equipment: (a) is more than 10 years old and has not been upgraded; or (b) was upgraded on or before it was 10 years old and is more than 15 years old |
| 16 | Diagnostic radiology equipment for mammography K‑type | a (K) item | Subgroup 10 of Group I3 | The equipment is 10 years old or less |
| 17 | Diagnostic radiology equipment for mammography K‑type upgraded | a (K) item | Subgroup 10 of Group I3 | The equipment: (a) is more than 10 years old and no more than 15 years old; and (b) was upgraded on or before it was 10 years old |
| 18 | Diagnostic radiology equipment for mammography NK‑type | an (NK) item | Subgroup 10 of Group I3 | The equipment: (a) is more than 10 years old and has not been upgraded; or (b) was upgraded on or before it was 10 years old and is more than 15 years old |
| 18A | Diagnostic radiology equipment for angiography K‑type | a (K) item | Subgroup 13 of Group I3 | The equipment is 10 years old or less |
| 19 | Diagnostic radiology equipment for angiography K‑type upgraded | a (K) item | Subgroup 13 of Group I3 | The equipment: (a) is more than 10 years old and no more than 15 years old; and (b) was upgraded on or before it was 10 years old or before 1 January 2016 |
| 20 | Diagnostic radiology equipment for angiography NK‑type | an (NK) item | Subgroup 13 of Group I3 | The equipment: (a) is more than 10 years old and has not been upgraded; or (b) was upgraded on or before it was 10 years old or before 1 January 2016, and is more than 15 years old |
| 21 | Diagnostic radiology equipment for fluoroscopic examination K‑type | a (K) item | Subgroup 15 or 17 of Group I3 | The equipment is 15 years old or less |
| 22 | Diagnostic radiology equipment for fluoroscopic examination K‑type upgraded | a (K) item | Subgroup 15 or 17 of Group I3 | The equipment: (a) is more than 15 years old and no more than 20 years old; and (b) was upgraded on or before it was 15 years old |
| 23 | Diagnostic radiology equipment for fluoroscopic examination NK‑type | an (NK) item | Subgroup 15 or 17 of Group I3 | The equipment: (a) is more than 15 years old and has not been upgraded; or (b) was upgraded on or before it was 15 years old and is more than 20 years old |
| 24 | Diagnostic radiology equipment for orthopantomography K‑type | item 57960, 57963, 57966 or 57969 | Subgroup 3 of Group I3 | The equipment is 15 years old or less |
| 25 | Diagnostic radiology equipment for orthopantomography K‑type upgraded | item 57960, 57963, 57966 or 57969 | Subgroup 3 of Group I3 | The equipment: (a) is more than 15 years old and no more than 20 years old; and (b) was upgraded on or before it was 15 years old |
| 26 | Diagnostic radiology equipment for orthopantomography NK‑type | an (NK) item | Subgroup 3 of Group I3 | The equipment: (a) is more than 15 years old and has not been upgraded; or (b) was upgraded on or before it was 15 years old and is more than 20 years old |
| 27 | Diagnostic radiology equipment X‑ray K‑type | a (K) item | Subgroups 1 to 9 (other than items 57960, 57963, 57966 and 57969), 11, 12 and 14 of Group I3 | The equipment is 15 years old or less |
| 28 | Diagnostic radiology equipment X‑ray K‑type upgraded | a (K) item | Subgroups 1 to 9 (other than items 57960, 57963, 57966 and 57969), 11, 12 and 14 of Group I3 | The equipment: (a) is more than 15 years old and no more than 20 years old; and (b) was upgraded on or before it was 15 years old |
| 29 | Diagnostic radiology equipment X‑ray NK‑type | an (NK) item | Subgroups 1 to 9 (other than items 57959, 57962, 57965 and 57968), 11, 12 and 14 of Group I3 | The equipment: (a) is more than 15 years old and has not been upgraded; or (b) was upgraded on or before it was 15 years old and is more than 20 years old |
(2) Clause 1.2.2 of the diagnostic imaging services table (age of equipment) applies, for this regulation, in the same way as that clause applies for the diagnostic imaging services table.
20CA Method for determining substantial difference from market value
(1) For subsection 23DZZIF(9) of the Act, the method mentioned in subregulation (2) is prescribed for working out whether the amount of a payment or of consideration for property, goods or services is substantially different from the market value of the property, goods or services.
(2) The amount of the payment or consideration is substantially different from the market value, determined in accordance with regulation 20CB, if the difference between the market value and the payment or consideration is more than 20% of the market value.
20CB Method for determining market value
(1) For subsection 23DZZIF(9) of the Act, the market value of property, goods or services is the amount that a willing purchaser would have had to pay, at the time mentioned in subregulation (2), to a vendor who was willing, but not anxious, to sell.
(2) The time is:
(a) for an offence of asking for a benefit that is not a permitted benefit—when the person asked for the benefit; or
(b) for an offence of accepting a benefit that is not a permitted benefit—when the person accepted the benefit; or
(c) for an offence of offering a benefit that is not a permitted benefit—when the person offered the benefit; or
(d) for an offence of providing a benefit that is not a permitted benefit—when the person provided the benefit.
20D Radiation oncology—information to be included in application for registration
For paragraph 23DZZO(1)(d) of the Act, the other information to be included in an application for registration of radiation oncology premises or a base for radiation oncology equipment is:
(a) the nature of the practice; and
(b) details of the radiation oncology equipment ordinarily located at the premises or base, including:
(i) the quantity of equipment of each type mentioned in regulation 20F; and
(ii) the functionality of the equipment; and
(iii) if the equipment has a serial number or other identifying number—that number.
Examples for paragraph (a): The practice might be a base for mobile equipment, a specialist radiation oncology practice (either on a stand‑alone practice site or co‑located with a primary care practice or group), a primary care practice, a sports medicine clinic or a public hospital.
20E Radiation oncology—information to be included on register
For subparagraph 23DZZP(1)(b)(iv) of the Act, the other information to be included on the register is the information included in the application for registration.
20F Primary information—types of radiation oncology equipment
For subsection 23DZZQ(2) of the Act, the following types of radiation oncology equipment are prescribed:
(a) megavoltage equipment—that is, equipment used in the rendering of a radiation oncology service described in subgroup 3 of Group T2 in the general medical services table;
(b) planning equipment—that is, equipment used in the rendering of a radiation oncology service described in subgroup 5 of Group T2 in the general medical services table;
(c) brachytherapy equipment—that is, equipment used in the rendering of a radiation oncology service described in subgroup 4 of Group T2 in the general medical services table.
21 Application form—application for approval as an organisation under Part IV of the Act
(1) For the purposes of subsection 40(1) of the Act, the prescribed form, in accordance with which an application under that subsection by an organization for approval as an organization under Part IV of the Act shall be made, is Form 1 in Schedule 1.
(2) An application under subsection 40(1) of the Act by an organization shall be signed by a person, being one of the persons responsible for the management of the organization, authorized in writing by the organization to sign that application.
22 Application form—application for approval of health service
(1) For the purposes of subsection 41(1) of the Act, the prescribed form, in accordance with which an application under that subsection by an organization for approval of a health service shall be made, is Form 2 in Schedule 1.
(2) An application under subsection 41(1) of the Act by an organization shall be signed by a person, being one of the persons responsible for the management of the organization, authorized in writing by the organization to sign the application.
23 Prescribed fee—subsection 61(1A) of the Act
For the purposes of subsection 61(1A) of the Act, the prescribed fee is $30.
23A Application for a declaration that a quality assurance activity is an activity to which Part VC of the Act applies
(1) A person who wants the Minister to declare that a quality assurance activity is an activity to which Part VC of the Act applies must apply to the Minister using the form approved by the Minister for the purposes of this regulation.
(2) The form must require the applicant to give:
(a) an undertaking that the applicant will inform the Minister of a change to the purposes of the quality assurance activity to which the application relates as soon as practicable after the change occurs; and
(b) if the quality assurance activity to which the application relates is to be engaged in by a body of persons—an undertaking that the applicant will inform the Minister of any significant change to the composition or purposes of the body that is likely to affect the activity as soon as practicable after the change occurs.
23B Criteria in relation to quality assurance activities
For the purposes of paragraph 124X(3)b) of the Act, the criteria stated in regulations 23C to 23G (inclusive) are prescribed.
23C Criteria in relation to quality assurance activities: disclosure of information
(1) A quality assurance activity must include the disclosure of information that concerns:
(a) the quality of service assessed, evaluated or studied; or
(b) the factors affecting the quality of the service.
(2) Disclosure of information:
(a) must not identify, expressly or by implication, a particular individual or particular individuals; and
(b) must take place:
(i) at times that are acceptable to the Minister; and
(ii) in a manner that is acceptable to the Minister.
(3) Subregulations (1) and (2) do not apply if the Minister is satisfied on reasonable grounds that it is not appropriate to disclose the information.
23D Criteria in relation to quality assurance activities: activities engaged in in one State or Territory
(1) The criterion stated in subregulation (2) applies if a quality assurance activity is engaged in in only one State or Territory.
(2) The Minister must be satisfied on reasonable grounds that at least one of the following paragraphs is relevant to a quality assurance activity engaged in in one State or Territory:
(a) the government of the State or Territory has advised the Minister that:
(i) the activity is not subject to legislation of the State or Territory that is similar to Part VC of the Act; and
(ii) in the opinion of the government of the State or Territory, it is in the public interest that Part VC of the Act should apply to the activity;
(b) the activity includes a methodology that has not been used previously in Australia;
(c) the activity is a pilot study for the purpose of investigating whether a methodology of a particular kind can be used in Australia;
(d) the activity addresses a subject matter that has not previously been addressed in Australia;
(e) the activity has the potential to affect the quality of health care on a national scale;
(f) the activity is a pilot study for the purpose of investigating whether the activity has the potential to affect the quality of health care on a national scale;
(g) the activity is of national importance.
23E Criteria in relation to quality assurance activities: activities that have not been engaged in previously in Australia
(1) The criterion stated in subregulation (2) applies if the Minister:
(a) is considering whether to make a declaration under subsection 124X(1) of the Act in relation to a quality assurance activity; and
(b) is satisfied on reasonable grounds that quality assurance activities of that kind have not been engaged in in Australia before he or she considers whether to make the declaration.
(2) The Minister must be satisfied on reasonable grounds that the application of Part VC of the Act to a quality assurance activity is necessary to make the activity effective by encouraging:
(a) the full participation in the activity of persons who provide health services; and
(b) if the activity involves the making of a recommendation to improve or maintain the quality of health services—the acceptance and implementation of the recommendation by persons who provide health services; and
(c) if the activity involves the making of a recommendation to improve or maintain the quality of health services—the participation of persons who provide health services in monitoring the implementation of the recommendation.
23F Criteria in relation to quality assurance activities: activities that have been engaged in previously in Australia
(1) The criteria stated in this regulation apply if the Minister:
(a) is considering whether to make a declaration under subsection 124X(1) of the Act in relation to a quality assurance activity (in this regulation called the activity); and
(b) is satisfied on reasonable grounds that a quality assurance activity of that kind (in this regulation called a previous activity) has been engaged in in Australia.
(2) The Minister must be satisfied on reasonable grounds that the application of Part VC of the Act to the activity is necessary to make the activity effective by encouraging participation in the activity:
(a) by persons who provide health services; and
(b) to a greater extent than the participation, by persons who provide health services, in the previous activity.
(3) If the activity involves the making of a recommendation to improve or maintain the quality of health services, the Minister must be satisfied on reasonable grounds that the application of Part VC of the Act to the activity is necessary to make the activity effective by encouraging acceptance and implementation of the recommendation:
(a) by persons who provide health services; and
(b) to a greater extent than the acceptance and implementation, by persons who provide health services, of recommendations made during the previous activity.
(4) If the activity involves the making of a recommendation to improve or maintain the quality of health services, the Minister must be satisfied on reasonable grounds that the application of Part VC of the Act to the activity is necessary to make the activity effective by encouraging participation in monitoring the implementation of the recommendation:
(a) by persons who provide health services; and
(b) to a greater extent than the participation, by persons who provide health services, in monitoring the implementation of recommendations made during the previous activity.
23G Criteria in relation to quality assurance activities: review procedures
(1) The criterion stated in subregulation (2) applies if a quality assurance activity includes:
(a) the assessment or evaluation by a person of the services, skill or performance of a health care practitioner for the purpose of determining the health care practitioner’s clinical practising rights; and
(b) the making of findings on material questions of fact or law.
(2) The purposes of the quality assurance activity must include:
(a) the giving of reasons to the health care practitioner for findings:
(i) that the person makes; and
(ii) with which the health care practitioner is dissatisfied; and
(b) an entitlement for the health care practitioner to appeal to another person or body against an adverse finding made by the person; and
(c) the disclosure, by the person, of information that:
(i) is about the health care practitioner’s clinical practising rights; and
(ii) identifies the health care practitioner.
(3) In this regulation:
clinical practising rights means:
(a) a health care practitioner’s right to practise a particular profession or use particular skills in:
(i) premises at which health services are provided; or
(ii) an authority of a State or Territory; or
(b) a health care practitioner’s right to hold himself or herself out as having been certified by an association of health professionals as possessing a particular skill or competency.
health care practitioner means a person referred to in paragraph (a) of the definition of quality assurance activity in subsection 124W(1) of the Act.
24 Allowances for witnesses at hearings before a Professional Services Review Committee
For the purposes of subsection 106C(1) of the Act, the allowances payable in respect of attendance by a witness at a hearing before a Professional Services Review Committee are the allowances ascertained by the Committee in accordance with Schedule 2.
25 Professional organisation—subsection 124B(1) of the Act
For the purposes of the definition of professional organisation in subsection 124B(1) of the Act, each of the following organisations or associations is declared to be a professional organisation:
(a) Australian Dental Association Incorporated;
(b) Australian Medical Association;
(c) Australian Optometrical Association.
25A Circumstances where fees etc cannot be charged for provision of public hospital services to public patients
(1) For section 128C of the Act, the circumstances are where a fee, payment or other consideration (however described) for the provision of an obstetric service:
(a) for a public patient in a public hospital; and
(b) by a medical practitioner or participating midwife, or a person acting on behalf of the medical practitioner:
(i) employed on the staff of the hospital; or
(ii) performing services under contract to the hospital.
(2) In this regulation:
obstetric service means a public hospital service:
(a) for attendance at, or associated with, the delivery of a baby; or
(b) requested or required by a public patient in connection with the delivery of a baby.
Example: The circumstances described by this regulation would include a booking fee or request for payment by a medical practitioner or participating midwife, or a person acting on behalf of the medical practitioner, employed by, or under contract to, a public hospital, for costs or charges of the medical practitioner or participating midwife for performing a public hospital service:
(a) by attending a public patient in the hospital to deliver a baby; or
(b) associated with the delivery of a baby for a public patient; or
(c) requested or required by a public patient in connection with the delivery of a baby.
26 Prescribed rate of interest—subsection 129AC(2) of the Act
For the purposes of subsection 129AC(2) of the Act, the prescribed rate is 15 per cent per annum.
27 Prescribed authorities and persons for the purposes of subsection 130(3A) of the Act
(1) For the purposes of subsection 130(3A) of the Act:
(a) a person holding an office specified in column 2 of an item in Part 2 or 3 of Schedule 3 is a prescribed person; and
(b) information may be provided to a person holding an office specified in column 2 of an item in Part 2 or 3 of Schedule 3, being information:
(i) of the kind indicated in column 3 of that item;
(ii) for the purpose of checking whether:
(A) a claim in respect of the same service has been made on both the Department of Veterans’ Affairs and the Chief Executive Medicare; or
(B) a claim that should have been made on the Chief Executive Medicare has been made on that Department; or
(C) a claim that should have been made on that Department has been made on the Chief Executive Medicare; or
(D) a claim that has been either paid or rejected by the Chief Executive Medicare has been made on that Department.
(2) For purposes of subsection 130(3A) of the Act:
(a) an authority specified in Part 4 of Schedule 3 is a prescribed authority; and
(b) a person specified in that Part is a prescribed person; and
(c) an authority of a State or Territory specified in Part 5 of that Schedule is a prescribed authority.
(3) For the purposes of subsection 130(3A) of the Act, if:
(a) a patient has complained to the Chief Executive Medicare about a medical practitioner and the Chief Executive Medicare, on reasonable grounds, considers that that complaint could be the subject of an investigation by a Medical Board or the Complaints Unit; or
(b) the Chief Executive Medicare believes, on reasonable grounds, that a patient has complained to a Medical Board or to the Complaints Unit about such a practitioner; or
(c) a patient has received a service from such a practitioner who is the subject of an investigation by the Chief Executive Medicare, a Medical Board or the Complaints Unit;
the kind of information that may be made available to a person from time to time holding, occupying or performing the duties of an office specified in Part 2 or 3 of Schedule 3 or an authority, or a person, referred to in subregulation (2) is:
(d) in relation to the patient—the information specified in subregulation (5); and
(e) in relation to the practitioner—the information specified in subregulation (7).
(4) Information relating to a practitioner, or to a patient of a practitioner, may not be made available to an authority, or to a person, specified in Part 4 or 5 of Schedule 3 unless:
(a) the authority is a prescribed authority; or
(b) the person is a prescribed person;
of the State or Territory:
(c) in relation to which the practitioner:
(i) is registered or licensed; or
(ii) was registered or licensed; or
(iii) is applying to be registered or licensed;
to practice as a medical practitioner; or
(d) in which the practitioner is or was practising.
(5) For the purposes of subregulation (3), the information relating to the patient is:
(a) name including any former name; and
(b) residential address including postcode and, if the patient’s postal address is another address, that other address including postcode; and
(c) residential telephone number; and
(d) work telephone number; and
(e) whether male or female; and
(f) date of birth; and
(g) medicare card number; and
(h) if the patient is not a permanent Australian resident:
(i) date of last entry into Australia;
(ii) expected date of departure from Australia;
(iii) name of country of residence.
(6) If:
(a) the information specified in subregulation (5) in relation to a patient may be made available to an authority or person in accordance with subregulation (3); and
(b) the Chief Executive Medicare, on reasonable grounds, considers that a claim by the patient for medicare benefits is relevant to an investigation;
the Chief Executive Medicare may also permit the following information relating to that claim to be made available to that authority or person:
(c) date on which that treatment was given; and
(d) item number for that treatment; and
(e) name and provider number of the provider giving that treatment; and
(f) name and provider number of the provider nominated by the servicing provider as the person to whom payment for those services should be directed; and
(g) date marked on the patient’s claim form as the date of that claim; and
(h) date on which that form was lodged with the Chief Executive Medicare.
(7) For the purposes of subregulation (3), the information relating to the practitioner is:
(a) name; and
(b) in respect of the practitioner’s practice or, if the practitioner has more than one practice, in respect of each practice:
(i) address including postcode; and
(ii) provider number; and
(iii) date on which it was opened; and
(iv) date (if any) on which it was closed; and
(c) particulars of claims for medicare benefits lodged by the practitioner that the Chief Executive Medicare, on reasonable grounds, considers are relevant to the investigation.
(8) For the purposes of subregulation (7), if a practitioner has a practice at more than one location, each of those locations is to be regarded as a separate practice.
28 Delegation
The Chief Executive Medicare may, by writing, delegate to a Departmental employee (within the meaning given by section 3 of the Human Services (Medicare) Act 1973) all or any of the powers and functions of the Chief Executive Medicare under regulation 27.
29 Manner of patient referrals
(1) For section 132A of the Act, this regulation and regulations 30 and 31 set out the manner in which a patient is to be referred by a referring practitioner to another practitioner for the purposes of:
(a) an item in the general medical services table; or
(b) an item in a determination made under subsection 3C(1) of the Act;
specifying a service to be rendered by a specialist or consultant physician, in the practice of his or her speciality, to a patient referred to the specialist or consultant physician.
(2) The referring practitioner must consider the need for the referral.
(3) The referral must give the specialist, or consultant physician, any information about the patient’s condition that the referring practitioner considers necessary.
(4) Unless subregulation 30(1) or (2) applies, a referral must be:
(a) given in writing; and
(b) signed by the referring practitioner; and
(c) dated.
(4A) If the referring practitioner is a specialist, or consulting physician, the referral must:
(a) be endorsed with the name of the general practitioner, participating midwife or participating nurse practitioner nominated by the patient; or
(b) if the patient is unwilling or unable to nominate a general practitioner, participating midwife or participating nurse practitioner for the purposes of paragraph (a)—contain a statement to that effect.
(5) Unless subregulation 30(3) applies, the specialist or consultant physician must receive the referral before giving the service to the patient.
30 Referrals: special cases
(1) A referral is given for a professional service to a patient in a hospital who is not a public patient if the hospital records record the referring practitioner’s signature approving the referral.
(2) A referral need not be given in writing if the referring practitioner decides in an emergency that it is necessary in the patient’s interests for the patient to be referred to the specialist or consultant physician as soon as practicable without a written referral.
(3) Subregulation 29(5) does not apply if a written referral is lost, stolen or destroyed.
(4) If, in an emergency, a specialist or consultant physician:
(a) decides that it is necessary in the patient’s interest to give a professional service as soon as practicable and without a referral otherwise than under this subregulation; and
(b) gives that service to the patient;
the specialist or consultant physician is taken to have been the referring practitioner and to have given a referral for the service.
(5) For the purposes of subregulations (2) and (4), an emergency is a situation where the patient is treated by a medical practitioner within 30 minutes of presentation and that patient is:
(a) at risk of serious morbidity or mortality requiring urgent assessment and resuscitation; or
(b) suffering from suspected acute organ or system failure; or
(c) suffering from an illness or injury where the viability or function of a body part or organ is acutely threatened; or
(d) suffering from a drug overdose, toxic substance or toxin effect; or
(e) experiencing severe psychiatric disturbance whereby the health of the patient or other people is at immediate risk; or
(f) suffering acute severe pain where the viability or function of a body part or organ is suspected to be acutely threatened; or
(g) suffering acute significant haemorrhage requiring urgent assessment and treatment.
31 Period of validity for referrals
(1) Unless the period of validity for a referral is otherwise provided for in this regulation, the referral may state a period for which it remains valid and it will remain valid:
(a) if the referral provides for it to be valid for a fixed period—for the period so provided after the first service given in accordance with the referral; or
(b) if the referral provides for it to be valid indefinitely—for an indefinite period; or
(c) if the referral does not provide for its validity—for 12 months after the first service given in accordance with the referral.
(1A) A referral given by a specialist, or consultant physician, is valid:
(a) if the referred patient is a patient in a hospital:
(i) until the patient ceases to be a patient in a hospital; or
(ii) until 3 months after the first service given in accordance with the referral;
whichever is the later; or
(b) in any other case—until 3 months after the first service given in accordance with the referral.
(1B) A referral given by a participating midwife is valid:
(a) until 12 months after the first service given in accordance with the referral; and
(b) for 1 pregnancy only.
(1C) A referral given by a participating nurse practitioner is valid until 12 months after the first service given in accordance with the referral.
(2) A referral given under subregulation 30(1) is valid until the patient ceases to be a patient in the hospital who is not a public patient.
(3) A referral given under subregulation 30(2) or subregulation 30(4) is valid for only 1 attendance on the patient.
(4) A written referral that is lost, stolen or destroyed is valid for only 1 attendance on the patient.