Federal Register of Legislation - Australian Government

Primary content

SR 1999 No. 258 Regulations as amended, taking into account amendments up to Health Insurance (Repeal and Consequential Amendments) Regulations 2018
Administered by: Health
Registered 10 Oct 2018
Start Date 01 Oct 2018
Date of repeal 23 Feb 2019
Repealed by Health Insurance (Professional Services Review Scheme) Regulations 2019

Commonwealth Coat of Arms of Australia

Health Insurance (Professional Services Review) Regulations 1999

Statutory Rules No. 258, 1999

made under the

Health Insurance Act 1973

Compilation No. 7

Compilation date:                              1 October 2018

Includes amendments up to:            F2018L01366

Registered:                                         10 October 2018

 

About this compilation

This compilation

This is a compilation of the Health Insurance (Professional Services Review) Regulations 1999 that shows the text of the law as amended and in force on 1 October 2018 (the compilation date).

The notes at the end of this compilation (the endnotes) include information about amending laws and the amendment history of provisions of the compiled law.

Uncommenced amendments

The effect of uncommenced amendments is not shown in the text of the compiled law. Any uncommenced amendments affecting the law are accessible on the Legislation Register (www.legislation.gov.au). The details of amendments made up to, but not commenced at, the compilation date are underlined in the endnotes. For more information on any uncommenced amendments, see the series page on the Legislation Register for the compiled law.

Application, saving and transitional provisions for provisions and amendments

If the operation of a provision or amendment of the compiled law is affected by an application, saving or transitional provision that is not included in this compilation, details are included in the endnotes.

Editorial changes

For more information about any editorial changes made in this compilation, see the endnotes.

Modifications

If the compiled law is modified by another law, the compiled law operates as modified but the modification does not amend the text of the law. Accordingly, this compilation does not show the text of the compiled law as modified. For more information on any modifications, see the series page on the Legislation Register for the compiled law.

Self‑repealing provisions

If a provision of the compiled law has been repealed in accordance with a provision of the law, details are included in the endnotes.

  

  

  


Contents

Part 1—Introductory                                                                                                                                     1

1............ Name of Regulations..................................................................................................... 1

3............ Definition...................................................................................................................... 1

Part 2—Adequate and contemporaneous records                                                                       2

4............ Purpose of this Part....................................................................................................... 2

5............ An adequate record........................................................................................................ 2

6............ A contemporaneous record............................................................................................ 2

Part 3—Prescribed pattern of services                                                                                                3

7............ Definition...................................................................................................................... 3

8............ Purpose of this Part....................................................................................................... 3

9............ Practitioners affected by these Regulations.................................................................... 3

10.......... Circumstances constituting a prescribed pattern............................................................ 3

11.......... Exceptional circumstances............................................................................................. 3

Part 3A—Professional Services Review Committees                                                                 4

11A....... Allowances for witnesses at hearings............................................................................ 4

Part 4—Appropriate person or body for person under review                                          5

12.......... Appropriate person or body for conduct involving significant threat to life or health.... 5

13.......... Appropriate body for non‑compliance with professional standards.............................. 5

Schedule 1—Appropriate person or body for a person under review       6

Part 1—If person under review is a general practitioner                                                        6

Part 2—If person under review is not a general practitioner                                               7

Endnotes                                                                                                                                                                 8

Endnote 1—About the endnotes                                                                                                        8

Endnote 2—Abbreviation key                                                                                                            9

Endnote 3—Legislation history                                                                                                       10

Endnote 4—Amendment history                                                                                                     11


Part 1Introductory

  

1  Name of Regulations

                   These Regulations are the Health Insurance (Professional Services Review) Regulations 1999.

3  Definition

                   In these Regulations:

Act means the Health Insurance Act 1973.

Note:          Several other words and expressions used in these Regulations have the meaning given by the Act. The following are examples of words and expressions defined in Part VAA of the Act:

·      adequate and contemporaneous records

·      inappropriate practice

·      person under review

·      practitioner

·      profession

·      relevant period

·      service.

Part 2Adequate and contemporaneous records

  

4  Purpose of this Part

                   This Part sets out the standards to be met in order that a practitioner’s records of the rendering or initiation of services be adequate and contemporaneous records.

Note:          See subsection 82(3) of the Act for the significance of adequate and contemporaneous records.

5  An adequate record

                   For the definition of adequate and contemporaneous records in section 81 of the Act, the standard to be met in order that a record of service rendered or initiated be adequate is that:

                     (a)  the record clearly identify the name of the patient; and

                     (b)  the record contain a separate entry for each attendance by the patient for a service and the date on which the service was rendered or initiated; and

                     (c)  each entry provide clinical information adequate to explain the type of service rendered or initiated; and

                     (d)  each entry be sufficiently comprehensible that another practitioner, relying on the record, can effectively undertake the patient’s ongoing care.

6  A contemporaneous record

                   For the definition of adequate and contemporaneous records in section 81 of the Act, the standard to be met in order that a record of a service rendered or initiated be contemporaneous, is that record must be completed:

                     (a)  at the time the practitioner rendered or initiated the service; or

                     (b)  as soon as practicable after the service was rendered or initiated by the practitioner.

Part 3Prescribed pattern of services

7  Definition

                   For this Part:

professional attendance means a service of a kind mentioned in group A1, A2, A5, A6, A7, A9, A11, A13, A14, A15, A16, A17, A18, A19, A20, A21, A22 or A23 of Part 2 of the general medical services table.

8  Purpose of this Part

                   This Part prescribes the circumstances in which services rendered or initiated by a practitioner constitute a prescribed pattern of services for Part VAA of the Act.

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

9  Practitioners affected by these Regulations

                   For section 82A of the Act, the following groups of practitioners in the profession of medicine are groups to which these Regulations apply:

                     (a)  general practitioners;

                     (b)  other medical practitioners rendering professional attendances.

10  Circumstances constituting a prescribed pattern

                   For section 82A of the Act, the circumstances in which services that are professional attendances constitute a prescribed pattern of services are that 80 or more such services are rendered on each of 20 or more days in a 12 month period.

11  Exceptional circumstances

                   For subsection 82(1D) of the Act, the following circumstances are declared as constituting exceptional circumstances:

                     (a)  an unusual occurrence causing an unusual level of need for professional attendances;

                     (b)  an absence of other medical services, for patients of the person under review during the relevant period, having regard to:

                              (i)  the location of the practice of the person under review; and

                             (ii)  characteristics of the patients of the person under review.

Part 3AProfessional Services Review Committees

  

11A  Allowances for witnesses at hearings

             (1)  This section is made for the purposes of subsection 106C(1) of the Act and deals with allowances for expenses in respect of attendance by a person summoned to appear as a witness at a hearing before a Professional Service Review Committee.

Kinds of allowances

             (2)  The allowances for a witness are the following:

                     (a)  attendance allowance in accordance with subsection (3) or (4) as applicable;

                     (b)  travel allowance in accordance with subsection (5).

Amount of attendance allowance

             (3)  For a witness attending because of the witness’ professional, scientific or other special skill or knowledge the amount of attendance allowance is equal to the witness’ actual fees for preparing to give evidence and of attending to give evidence.

             (4)  For a witness other than a witness mentioned in subsection (3), the amount of attendance allowance is equal to:

                     (a)  if the witness is paid by wages—any wages actually lost because of the attendance; or

                     (b)  if the witness is paid by fees—any fees actually lost because of the attendance;

up to a maximum of $527 per day.

Amount of travel allowance

             (5)  The amount of travel allowance for a witness is a reasonable amount, determined by the Professional Services Review Committee, for:

                     (a)  transport to and from the hearing; and

                     (b)  if the witness is required to be absent overnight from the witness’ usual place of residence—meals and accommodation during the absence.

Part 4Appropriate person or body for person under review

  

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

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

13  Appropriate body for non‑compliance with professional standards

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

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

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

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

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

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


Schedule 1Appropriate person or body for a person under review

(regulations 12 and 13)

Part 1If person under review is a general practitioner

 

Item

Person or body

101

Medical Board of Australia

102

General Practice Recognition Appeal Committee

103

General Practice Recognition Eligibility Committee

104

The Royal Australian College of General Practitioners

105

Australian General Practice Accreditation Limited

106

Quality Practice Accreditation Pty Ltd trading as GPA Accreditation plus

Part 2If person under review is not a general practitioner

 

Item

Person or body

201

Chiropractic Board of Australia

202

Dental Board of Australia

203

Department of Human Services

204

Medical Board of Australia

205

Nursing and Midwifery Board of Australia

206

Optometry Board of Australia

207

Osteopathy Board of Australia

208

Physiotherapy Board of Australia

209

Podiatry Board of Australia

 


Endnotes

Endnote 1—About the endnotes

The endnotes provide information about this compilation and the compiled law.

The following endnotes are included in every compilation:

Endnote 1—About the endnotes

Endnote 2—Abbreviation key

Endnote 3—Legislation history

Endnote 4—Amendment history

Abbreviation key—Endnote 2

The abbreviation key sets out abbreviations that may be used in the endnotes.

Legislation history and amendment history—Endnotes 3 and 4

Amending laws are annotated in the legislation history and amendment history.

The legislation history in endnote 3 provides information about each law that has amended (or will amend) the compiled law. The information includes commencement details for amending laws and details of any application, saving or transitional provisions that are not included in this compilation.

The amendment history in endnote 4 provides information about amendments at the provision (generally section or equivalent) level. It also includes information about any provision of the compiled law that has been repealed in accordance with a provision of the law.

Editorial changes

The Legislation Act 2003 authorises First Parliamentary Counsel to make editorial and presentational changes to a compiled law in preparing a compilation of the law for registration. The changes must not change the effect of the law. Editorial changes take effect from the compilation registration date.

If the compilation includes editorial changes, the endnotes include a brief outline of the changes in general terms. Full details of any changes can be obtained from the Office of Parliamentary Counsel.

Misdescribed amendments

A misdescribed amendment is an amendment that does not accurately describe the amendment to be made. If, despite the misdescription, the amendment can be given effect as intended, the amendment is incorporated into the compiled law and the abbreviation “(md)” added to the details of the amendment included in the amendment history.

If a misdescribed amendment cannot be given effect as intended, the abbreviation “(md not incorp)” is added to the details of the amendment included in the amendment history.

Endnote 2—Abbreviation key

 

ad = added or inserted

o = order(s)

am = amended

Ord = Ordinance

amdt = amendment

orig = original

c = clause(s)

par = paragraph(s)/subparagraph(s)

C[x] = Compilation No. x

    /sub‑subparagraph(s)

Ch = Chapter(s)

pres = present

def = definition(s)

prev = previous

Dict = Dictionary

(prev…) = previously

disallowed = disallowed by Parliament

Pt = Part(s)

Div = Division(s)

r = regulation(s)/rule(s)

ed = editorial change

reloc = relocated

exp = expires/expired or ceases/ceased to have

renum = renumbered

    effect

rep = repealed

F = Federal Register of Legislation

rs = repealed and substituted

gaz = gazette

s = section(s)/subsection(s)

LA = Legislation Act 2003

Sch = Schedule(s)

LIA = Legislative Instruments Act 2003

Sdiv = Subdivision(s)

(md) = misdescribed amendment can be given

SLI = Select Legislative Instrument

    effect

SR = Statutory Rules

(md not incorp) = misdescribed amendment

Sub‑Ch = Sub‑Chapter(s)

    cannot be given effect

SubPt = Subpart(s)

mod = modified/modification

underlining = whole or part not

No. = Number(s)

    commenced or to be commenced

 

Endnote 3—Legislation history

 

Number and year

FRLI registration or gazettal

Commencement
date

Application, saving and transitional provisions

1999 No. 258

27 Oct 1999

1 Nov 1999

 

1999 No. 346

22 Dec 1999

1 Jan 2000

2001 No. 45

16 Mar 2001

16 Mar 2001

2006 No. 199

28 July 2006 (see F2006L02427)

29 July 2006

2011 No. 120

30 June 2011 (see F2011L01364)

1 July 2011

2012 No. 212

3 Sept 2012 (see F2012L01822)

4 Sept 2012

2012 No. 298

7 Dec 2012 (see F2012L02370)

27 Dec 2012

 

Name

Registration

Commencement

Application, saving and transitional provisions

Health Insurance (Repeal and Consequential Amendments) Regulations 2018

27 Sept 2018 (F2018L01366)

Sch 1 (item 19): 1 Oct 2018 (s 2(1) item 1)

 

Endnote 4—Amendment history

 

Provision affected

How affected

Part 1

 

r 2.............................................

rep LA s 48D

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

am. 1999 No. 346

 

rep. 2012 No. 212

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

ad. 1999 No. 346

 

rep. 2012 No. 212

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

ad. 2012 No. 212

 

rs. 2012 No. 298

Part 2

 

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

am. 2012 No. 212

Part 3

 

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

ad. 1999 No. 346

r. 7............................................

ad. 1999 No. 346

 

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

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

rep. 2012 No. 212

r. 8............................................

ad. 1999 No. 346

 

am. 2012 No. 298

r. 9............................................

ad. 1999 No. 346

 

am. 2012 No. 298

r. 10..........................................

ad. 1999 No. 346

 

am. 2012 No. 298

r. 11..........................................

ad. 1999 No. 346

 

am. 2012 No. 298

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

rep. 2012 No. 212

Part 3A

 

Part 3A......................................

ad F2018L01366

r 11A........................................

ad F2018L01366

Part 4

 

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

ad. 2006 No. 199

 

rs. 2012 No. 298

r. 12..........................................

ad. 2006 No. 199

 

am. 2012 No. 212

 

rs. 2012 No. 298

r. 13..........................................

ad. 2012 No. 298

Schedule 1

 

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

ad. 2006 No. 199

 

am. 2012 No. 212

 

rs. 2012 No. 298

Schedule 2

 

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

ad. 2006 No. 199

 

am. 2011 No. 120

 

rs. 2012 No. 212

 

rep. 2012 No. 298