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If a provision of the compiled law has been repealed in accordance with a provision of the law, details are included in the endnotes.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

3 Definition

Part 2—Adequate and contemporaneous records

4 Purpose of this Part

5 An adequate record

6 A contemporaneous record

Part 3—Prescribed pattern of services

7 Definition

8 Purpose of this Part

9 Practitioners affected by these Regulations

10 Circumstances constituting a prescribed pattern

11 Exceptional circumstances

Part 3A—Professional Services Review Committees

11A Allowances for witnesses at hearings

Part 4—Appropriate person or body for person under review

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

13 Appropriate body for non‑compliance with professional standards

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

Part 1—If person under review is a general practitioner

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

Endnotes

Endnote 1—About the endnotes

Endnote 2—Abbreviation key

Endnote 3—Legislation history

Endnote 4—Amendment history

Part 1—Introductory

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 2—Adequate and contemporaneous records

4  Purpose of this Part

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

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

5  An adequate record

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

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

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

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

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

6  A contemporaneous record

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

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

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

Part 3—Prescribed pattern of services

7  Definition

  For this Part:

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

8  Purpose of this Part

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

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

9  Practitioners affected by these Regulations

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

 (a) general practitioners;

 (b) other medical practitioners rendering professional attendances.

10  Circumstances constituting a prescribed pattern

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

11  Exceptional circumstances

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

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

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

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

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

Part 3A—Professional 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 4—Appropriate person or body for person under review

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

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

13  Appropriate body for non‑compliance with professional standards

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

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

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

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

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

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

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

(regulations 12 and 13)

Part 1—If person under review is a general practitioner

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

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

Endnote 3—Legislation history

Endnote 4—Amendment history