Document ID: chunk:federal_register_of_legislation:F2017L00274:schedule:1:p1
Version: federal_register_of_legislation:F2017L00274
Segment Type: schedule
Provision Reference: sch 1 (pt 1/3)
Character Range: 740–3529

Schedule 1—Repeals

1 The whole of the Determination

Part 1 Preliminary

1 Name of Determination

  This Determination is the Health Insurance (Professional Services Review – Sampling Methodology) Determination 2017.

2 Commencement

  This Determination commences on the day after it is registered.

3 Authority

  This Determination is made under section 106K of the Health Insurance Act 1973.

4 Schedules

  Each instrument that is specified in a Schedule to this Determination is amended or repealed as set out in the applicable items in the Schedule concerned, and any other item in a Schedule to this instrument has effect according to its terms.

5 Definitions

  In this Determination:
Act means the Health Insurance Act 1973.
final report means:
           (a)   a final report prepared under section 106L of the Act; or
           (b)   a draft report prepared under section 106KD of the Act that is, because of the operation of section 106KE of the Act, also a final report.

Note 1   The following terms that are used in this Determination are defined in subsection 3 (1) of the Act:
       initiate
       item.

Note 2   The following terms that are used in this Determination are defined in subsection 81 (1) of the Act:
       class of services
       Committee
       inappropriate practice
       person under review
       referred services
       service.

Part 2 Sampling methodology

6 Purpose

  This Part specifies the content and form of a sampling methodology that may be used by a Committee in investigating the provision of services included in a particular class of referred services, where regard is to be had only to a sample of the services included in the class.

7 Application of sampling methodology

  The sampling methodology specified in this Part is applicable to services provided, within the meaning given by subsection 81 (2) of the Act, that are:
 (a) individual items; or
 (b) multiple items for the same patient on 1 occasion;
in a particular class of referred services.

8 Sample

 (1) Under this methodology, the Committee must have regard to a sample of no fewer than 25 provided services randomly drawn from a class of referred services being investigated.

 (2) The Committee may:
 (a) omit a service from the sample; and
 (b) include another provided service, randomly drawn from the same class, in its place.

 (3) If the Committee omits a service and includes another provided service in its place under subsection (2), the Committee must state its reasons for doing so in the draft report and final report it prepares in respect of the person under review to whom the sample relates.

Note   The Committee must prepare a draft report under section 106KD of the Act, and a final report under section 106L of the