Source: https://www.legislation.gov.au/Details/F2020C00656
Timestamp: 2020-08-09 02:03:54
Document Index: 22406765

Matched Legal Cases: ['art 2', 'art 3', 'art 4', 'art 5', 'art 6', 'art 7', 'art 8', 'art 9', 'art 10', 'art 11', 'art 12']

Details: F2020C00656
- F2020C00656
Regulations as amended, taking into account amendments up to Health Insurance Amendment (General Practitioners) Regulations 2020
Health Insurance Amendment (2020 Measures No. 1) Regulations 2020 - F2020L00458
sch 1 (item 31)
Health Insurance Amendment (General Practitioners) Regulations 2020 - F2020L00794
sch 1 (items 5-12)
F2020C00656
Includes amendments up to: F2020L00794
This compilation includes a commenced amendment made by F2020L00458
This is a compilation of the Health Insurance Regulations 2018 that shows the text of the law as amended and in force on 1 July 2020 (the compilation date).
Part 2—Definitional material 4
Division 1—Participating midwives 4
5............ Participating midwives—specified collaborative arrangements and medical practitioners....... 4
6............ Midwife record‑keeping requirements for certain collaborative arrangements............... 5
Division 2—Participating nurse practitioners 7
7............ Participating nurse practitioners—specified collaborative arrangements and medical practitioners 7
8............ Nurse practitioner record‑keeping requirements for certain collaborative arrangements 8
Division 3—Definition of services 10
9............ Professional services—medical services rendered by approved dental practitioners... 10
10.......... Meaning of specialist trainee....................................................................................... 10
11.......... Professional services rendered by specialist trainees................................................... 10
12.......... Health service not specified in an item—meaning of health service............................. 10
Division 4—Recognition of medical practitioners as specialists and consultant physicians 12
13.......... Recognition of medical practitioner domiciled in Australia as specialist—meaning of relevant organisation and relevant qualification................................................................................................................. 12
14.......... Alternative method of recognition of medical practitioner domiciled in Australia as specialist or consultant physician—application fee.............................................................................................................. 12
15.......... Recognition of medical practitioner who is not domiciled in Australia—application fee 12
Division 5—General practitioners 13
Subdivision A—Recognised Fellows of the Royal Australian College of General Practitioners 13
16.......... Eligibility for determination as recognised Fellow of RACGP.................................... 13
17.......... Notice from RACGP to Chief Executive Medicare if RACGP does not consider applicant eligible for determination.................................................................................................................................... 13
18.......... Revocation of determination as recognised Fellow of RACGP................................... 13
Subdivision B—Vocationally registered general practitioners 13
19.......... ACRRM may give notice about applicant’s eligibility for vocational registration....... 13
19A....... Eligibility for vocational registration............................................................................ 13
20.......... Notice if professional body does not consider applicant eligible for vocational registration 14
21.......... ACRRM or Medical Board of Australia may give notice for removal from Vocational Register of General Practitioners.................................................................................................................................... 14
21A....... Requirement for removal from Vocational Register of General Practitioners.............. 14
Subdivision C—Recognised fellows of the Australian College of Rural and Remote Medicine 15
22.......... Determination as recognised Fellow of ACRRM........................................................ 15
23.......... Eligibility for determination as recognised Fellow of ACRRM................................... 15
24.......... Revocation of determination as recognised Fellow of ACRRM.................................. 16
Subdivision D—General practitioners for the purposes of section 20 of the Act 17
25.......... Medical practitioner who practises in general practice................................................. 17
Division 6—Register of Approved Placements 18
26.......... Specified bodies, courses and programs...................................................................... 18
27.......... Removal from the Register.......................................................................................... 20
Part 3—Medicare benefits 21
Division 1—Amount of medicare benefit 21
28.......... Entitlement to medicare benefit—services for which medicare benefit is 100% of Schedule fee 21
Division 2—Medicare benefits in relation to pathology services 23
Subdivision A—Simplified outline of this Division 23
29.......... Simplified outline of this Division............................................................................... 23
Subdivision B—Specifying services 23
30.......... Pathology service determined to be necessary by participating midwife...................... 23
31.......... Pathology service determined to be necessary by participating nurse practitioner....... 23
Subdivision C—Requirements for requests for pathology services 24
32.......... Purpose of Subdivision............................................................................................... 24
33.......... Information about requesting practitioner.................................................................... 24
34.......... Information about patient............................................................................................. 24
35.......... Information about pathology service........................................................................... 25
36.......... Requests that specify an approved pathology practitioner........................................... 25
37.......... Further requests........................................................................................................... 25
Division 3—Medicare benefits in relation to R‑type diagnostic imaging services 26
Subdivision A—Simplified outline of this Division 26
38.......... Simplified outline of this Division............................................................................... 26
Subdivision B—Specifying services for effective requests 26
39.......... Requests by dental practitioners.................................................................................. 26
40.......... Requests by chiropractors........................................................................................... 28
41.......... Requests by physiotherapists or osteopaths................................................................ 29
42.......... Requests by podiatrists................................................................................................ 29
43.......... Requests by participating midwives............................................................................ 29
44.......... Requests by participating nurse practitioners............................................................... 29
Subdivision C—Specifying services for pre‑existing diagnostic imaging practices 30
45.......... Exemption from subsection 16B(1) of the Act—pre‑existing diagnostic imaging practices 30
Division 4—Medicare benefits in relation to radiation oncology services 31
46.......... Meaning of radiation oncology service....................................................................... 31
Division 5—Particulars of professional services 32
47.......... Simplified outline of this Division............................................................................... 32
48.......... Purpose of Division.................................................................................................... 32
49.......... All services—particulars of patient, date of service and fees....................................... 32
50.......... All services—particulars of professional service rendered.......................................... 32
51.......... Most general medical services and Group P9 pathology services—particulars of person rendering service 33
52.......... Certain radiation or nuclear services—particulars of person rendering service and person claiming or receiving fees.................................................................................................................................... 33
53.......... Certain radiation oncology services—use of equipment.............................................. 34
54.......... Pathology services (other than Group P9)—particulars of person rendering service.. 34
55.......... Pathology services—other particulars......................................................................... 34
56.......... Diagnostic imaging services—particulars of person rendering service and person claiming or receiving fees 35
57.......... Diagnostic imaging services—other particulars........................................................... 36
58.......... Services provided upon referral................................................................................... 37
59.......... Multiple professional services in a single day............................................................. 38
60.......... Anaesthesia................................................................................................................. 38
Division 6—Professional services rendered by or on behalf of certain medical practitioners 40
61.......... Other circumstances in which subparagraphs 19AA(1)(b)(iv) and (2)(b)(iv) of the Act apply 40
62.......... Meaning of intern........................................................................................................ 40
Division 7—Payments to medical practitioners and approved billing agents 41
63.......... Circumstances for electronic payments to medical practitioners.................................. 41
64.......... Requirements for payments to specialists and consultant physicians........................... 41
65.......... Approved billing agents—application requirements and fee........................................ 42
Division 8—Eligible midwives 43
66.......... Meaning of eligible midwife—requirements................................................................ 43
Part 4—Special provisions relating to pathology 44
67.......... Giving notice of termination of undertaking................................................................ 44
68.......... Approved pathology authorities—other records of pathology services....................... 44
69.......... Offences in relation to request forms—branded pathology request forms................... 44
Part 5—Special provisions relating to diagnostic imaging services 46
70.......... Requests for diagnostic imaging services—information and form requirements......... 46
71.......... Medical practitioners rendering diagnostic imaging services—other records of services 47
72.......... Diagnostic Imaging Register—other information to be included in application for registration 47
73.......... Diagnostic Imaging Register—other information to be included on Register.............. 48
74.......... Primary information—types of diagnostic imaging equipment.................................... 48
75.......... Diagnostic imaging accreditation—information to be included on Diagnostic Imaging Register 49
Part 6—Prohibited practices in relation to pathology services and diagnostic imaging services 50
76.......... Meaning of permitted benefit—method for determining substantial difference from market value 50
77.......... Meaning of permitted benefit—method for determining market value......................... 50
Part 7—Radiation Oncology Register 51
78.......... Radiation Oncology Register—other information to be included in application for registration 51
79.......... Radiation Oncology Register—other information to be included on the Register........ 51
80.......... Primary information—types of radiation oncology equipment.................................... 51
Part 8—Health program grants 52
81.......... Form for application for approval as an organization under Part IV of the Act........... 52
82.......... Form for application for approval of health service..................................................... 52
Part 9—Medicare Participation Review Committees 53
83.......... Meaning of professional organisation........................................................................ 53
Part 10—Quality assurance confidentiality 54
Division 1—Quality assurance activities—application for declaration 54
84.......... Application for declaration that quality assurance activity is activity to which Part VC of the Act applies 54
Division 2—Quality assurance activities—public interest criteria 55
85.......... Purpose of Division.................................................................................................... 55
86.......... Disclosure of information about quality assurance activities....................................... 55
87.......... Quality assurance activities engaged in in a single State or Territory........................... 55
88.......... Quality assurance activities of a kind that has not previously been engaged in in Australia 56
89.......... Quality assurance activities of a kind that has previously been engaged in in Australia 56
Part 11—Miscellaneous provisions 57
Division 1—Charging of fees for provision of public hospital services to public patients 57
90.......... Circumstances in which fees must not be charged for provision of public hospital services to public patients 57
Division 2—Recovery of amounts 58
91.......... Recovery of debts due to the Commonwealth—prescribed rate of interest.................. 58
Division 3—Divulging and using information 59
92.......... Divulging information—treatment provided to veterans.............................................. 59
93.......... Divulging information—complaints and investigations............................................... 59
94.......... Professional disciplinary and regulatory bodies.......................................................... 61
Division 4—Manner of patient referrals 62
95.......... Purpose and application of Division............................................................................ 62
96.......... Who can make referral................................................................................................. 62
97.......... Requirement to consider need for referral.................................................................... 62
98.......... Requirements for form of referral................................................................................ 62
99.......... Requirements for contents of referral.......................................................................... 63
100........ Requirement to record certain referrals in hospital records.......................................... 63
101........ Receipt of referral by specialist or consultant physician.............................................. 63
102........ Period of validity for referrals..................................................................................... 64
Part 12—Application, saving and transitional provisions 66
Division 1—Transitional matters relating to the repeal of the Health Insurance Regulations 1975 66
103........ Things done under the Health Insurance Regulations 1975........................................ 66
Division 2—Application provision relating to the Health Insurance Amendment (General Practitioners) Regulations 2020 67
104........ Application of section 21A.......................................................................................... 67
Schedule 1—Specialists 68
1............ Organisations, specialties and qualifications................................................................ 68
Schedule 2—Forms 73
Form 1—Application for approval as an organization under Part IV of the Act 73
Form 2—Application for approval of a health service 74
health practitioner means a person practising a profession that, under the Health Practitioner Regulation National Law, is regulated by a National Board.
Health Practitioner Regulation National Law means:
National Board means any of the following:
(a) the Aboriginal and Torres Strait Islander Health Practice Board of Australia;
(b) the Chiropractic Board of Australia;
(c) the Dental Board of Australia;
(d) the Medical Board of Australia;
(e) the Medical Radiation Practice Board of Australia;
(f) the Nursing and Midwifery Board of Australia;
(g) the Occupational Therapy Board of Australia;
(h) the Optometry Board of Australia;
(i) the Osteopathy Board of Australia;
(j) the Physiotherapy Board of Australia;
(k) the Podiatry Board of Australia;
(l) the Psychology Board of Australia.
(b) all items in Groups T2, T3, T4, T6, T7, T11, T10, T8 and T9.
90350, 90355, 90360, 90361, 90362, 90365
(2) For the purposes of paragraph 10(2)(aa) of the Act, a service specified in an item of the diagnostic imaging services table to which clause 1.2.18 or 1.2.19 of that table applies is prescribed.
57509, 57515, 57521, 57523, 57527, 57901 to 57969, 58100, 58300, 58503, 58903, 59733, 59739, 59751, 60500, 60503
55028, 55030, 55032
56001 to 56220, 56224, 56301 to 56507, 56801 to 57007, 57341, 57362
57703, 57709, 57712, 57715, 58103 to 58115, 58306, 58506, 58521 to 58527, 58909, 59103, 59703, 60000 to 60009, 60506, 60509, 61109
61372, 61421, 61425, 61429, 61430, 61433, 61434, 61446, 61449, 61450, 61453, 61454, 61457, 61462
63007, 63334
56013, 56016, 56022, 56028, 57362
61421, 61425, 61429, 61430, 61433, 61434, 61446, 61449, 61450, 61453, 61454, 61457, 61462
56022, 57362
61421, 61454, 61457
56001, 56007, 56010, 56013, 56016, 56022, 56028, 56101, 56107, 56301, 56307, 56401, 56407, 57341, 57362
58306, 58506, 58909, 59103, 59703, 60000 to 60009, 60506, 60509, 61109
57712, 57715, 58100 to 58106, 58109, 58112
57712, 57715, 58100 to 58106, 58109, 58112, 58120, 58121
55844, 55888, 55889, 55890, 55891, 55892, 55893, 55894, 55895
57521, 57523, 57527
55700, 55704, 55706, 55707, 55718
55036, 55066, 55070, 55071, 55076, 55600, 55768, 55812, 55844, 55848, 55850, 55852, 55856, 55857, 55858, 55859, 55860, 55861, 55862, 55863, 55864, 55865, 55866, 55867, 55868, 55869, 55870, 55871, 55872, 55873, 55874, 55875, 55876, 55877, 55878, 55879, 55880, 55881, 55882, 55883, 55884, 55885, 55886, 55887, 55888, 55889, 55890, 55891, 55892, 55893, 55894, 55895
57509, 57515, 57521, 57523, 57527, 57703, 57709, 57712, 57715, 57721, 58503 to 58527
57712, 57715, 57901, 57902, 57907, 57915, 57921, 58100 to 58115, 58521, 58524, 58527, 58700, 59103
service time has the meaning given by clause 5.9.3 in the general medical services table.
Items in Subgroups 1, 2, 3 (except items 57960 to 57969), 4 to 9, 12 and 14 of Group I3
Items 57960 to 57969
(iva) the Treatment Benefits (Special Access) Act 2019;
(i) the Australian Health Practitioner Regulation Agency;
(ii) a National Board;
(iia) each State or Territory Board of a National Board;
(a) a patient has complained to the Chief Executive Medicare about a health practitioner; and
(3) Information may be provided to an authority mentioned in any of subparagraphs (1)(a)(i) to (iv) if the authority tells the Chief Executive Medicare that a patient has made a complaint to the authority about a health practitioner.
(5) Information may be provided to an authority or person mentioned in paragraph (1)(a) if a health practitioner is the subject of an investigation by the Chief Executive Medicare.
(a) the health practitioner is, was, or is applying to be, registered or licensed to practice in that State or Territory; or
(b) the health practitioner is or was practising in that State or Territory.
(7) The following information may be provided in relation to a health practitioner who is the subject of a complaint or investigation mentioned in subsection (2), (3) or (5):
(b) the address of each location at which the health practitioner practises (including any former location at which the health practitioner practised in the period that is the subject of the complaint or investigation);
(c) if the health practitioner has been allocated a provider number or requester number—the number;
(d) whether the health practitioner has previously been the subject of an investigation by the Chief Executive Medicare and, if so, the status of the investigation.
(8) Information relating to a service may be provided if:
(a) a health practitioner who is the subject of a complaint or investigation mentioned in subsection (2), (3) or (5):
(i) rendered the service; or
(ii) supervised the rendering of the service; or
(iii) requested the service; or
(iv) claimed or received payment of fees in relation to the service; or
(v) was the assignee under an assignment or agreement, made or entered into in accordance with section 20A of the Act, in relation to the medicare benefit in respect of the service; and
(b) the Chief Executive Medicare reasonably believes that the service is relevant to the complaint or investigation.
(9) The information mentioned in subsection (10) relating to a patient may be provided if the patient has made a complaint mentioned in subsection (2) or (3).
(9A) The information mentioned in subsection (10) relating to a patient may also be provided if:
(a) the patient has received a service; and
(b) a health practitioner who is the subject of a complaint or investigation mentioned in subsection (2), (3) or (5):
(c) the Chief Executive Medicare reasonably believes that the service is relevant to the complaint or investigation.
(10) For the purposes of subsections (9) and (9A), the information relating to the patient is the following:
(i) date of last entry into Australia; and
(ii) expected date of departure from Australia; and
Health Legislation Amendment (Permitted Information Disclosure) Regulations 2020
24 Mar 2020 (F2020L00294)
Sch 1 (items 1–12): 25 Mar 2020 (s 2(1) item 1)
Health Insurance Amendment (2020 Measures No. 1) Regulations 2020
22 Apr 2020 (F2020L00458)
Sch 1 (items 1–30): 1 May 2020 (s 2(1) item 2)
Sch 1 (item 31): 1 July 2020 (s 2(1) item 3)
26 June 2020 (F2020L00794)
Sch 1 (items 1–4): 27 June 2020 (s 2(1) item 2)
Sch 1 (items 5–12): awaiting commencement (s 2(1) item 3)
am F2020L00294; F2020L00794 (Sch 1 item 5)
am F2020L00458
rs F2020L00794
rep F2020L00794
ad F2020L00794
am F2020L00794
am F2018L01481; F2019L00179; F2019L01256; F2020L00458
am F2018L01481; F2020L00458
s 92...........................................
am F2020L00294