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HEALTH INSURANCE ACT 1973 - SECT 81

Definitions

  (1)   In this Part, unless the contrary intention appears:

"adequate and contemporaneous records" of the rendering or initiation of services means records that meet the standards prescribed by the regulations for the purposes of this definition.

"AMA" means the Australian Medical Association Limited (A.C.N. 008426793).

"Associate Director" means an Associate Director of Professional Services Review appointed under section   83A.

Note:   In this Part, a reference to the Director includes a reference to an Associate Director, subject to certain exceptions (see subsection   83A(2)).

"Authority" means the Determining Authority.

"Chair" means Chair of the Authority.

"Chair of the Authority" includes a person acting in the office of Chair of the Authority.

"Chairperson" means the Chairperson of a particular Committee.

"class of services" means services of the same kind, or similar kinds.

"Committee" means a Professional Services Review Committee set up under section   93.

"Committee investigation" means an investigation by a Committee under Division   4.

"Committee member" means a member of a Committee.

"Deputy Director" means a Deputy Director of Professional Services Review appointed under section   85.

"Determining Authority" means the Determining Authority established by section   106Q.

"Director" means the Director of Professional Services Review appointed under section   83.

Note:   In this Part, a reference to the Director includes a reference to an Associate Director, subject to certain exceptions (see subsection   83A(2)).

"Director's review" means a review undertaken by the Director under Division   3A.

"document" includes any record.

"executive officer" of a body corporate means a person, by whatever name called and whether or not a director of the body, who is concerned in, or takes part   in, the management of the body.

"findings" , in relation to a draft report or final report of a Committee, means the Committee's findings as to whether the person under review engaged in inappropriate practice in the provision of some or all of the services specified in the referral made to the Committee.

"inappropriate practice" has the meanings given in section   82.

"lawyer" means a barrister or a solicitor.

"legal services" means:

  (a)   in respect of the Director--giving legal advice to the Director (including legal advice in respect of the preparation of a report to accompany a referral); and

  (b)   in respect of a Committee:

  (i)   giving legal advice to the Committee (including legal advice in respect of the preparation of a draft or final report); and

  (ii)   attending hearings of the Committee to give legal assistance to the Committee in respect of the hearing; and

  (c)   in respect of the Determining Authority--giving legal advice to the Authority in respect of:

  (i)   its consideration of an agreement made under section   92; or

  (ii)   the preparation of a draft or final determination.

"member" of the Authority includes a person acting in an office of member of the Authority and, to avoid doubt, includes the Chair of the Authority.

"Panel" means the Professional Services Review Panel established under subsection   84(1).

"Panel member" means a member of the Panel appointed under subsection   84(2).

"person under review" means:

  (a)   in relation to a Director's review of the provision of services by a person--that person; or

  (b)   in relation to a Committee investigation into whether a person engaged in inappropriate practice--that person.

"pharmaceutical benefit" means a pharmaceutical benefit as defined in Part   VII of the National Health Act 1953 .

"practitioner" means:

  (a)   a medical practitioner; or

  (b)   a dental practitioner; or

  (d)   an optometrist; or

  (da)   a midwife; or

  (db)   a nurse practitioner; or

  (e)   a chiropractor; or

  (f)   a physiotherapist; or

  (g)   a podiatrist; or

  (h)   an osteopath; or

  (i)   a health professional of a kind determined by the Minister under subsection   (1A) to be a practitioner for the purposes of this Part.

"prescribed pattern of services" has the meaning given by section   82A.

"profession" means the group of persons engaged in one of the following vocations:

  (a)   medicine;

  (b)   dentistry;

  (c)   optometry;

  (ca)   midwifery;

  (cb)   the practice of a nurse practitioner;

  (d)   chiropractic;

  (e)   physiotherapy;

  (f)   podiatry;

  (g)   osteopathy;

  (h)   a vocation determined by the Minister under subsection   (1A) to be a profession for the purposes of this Part.

"provides services" has the meaning given by subsection   (2).

"referral" means a referral to a Committee under section   93.

"referred services" , in relation to a Committee investigation, means the services specified in the referral made to the Committee under section   93.

"relevant DVA law" means any of the following:

  (a)   the Australian Participants in British Nuclear Tests and British Commonwealth Occupation Force (Treatment) Act 2006 ;

  (b)   Chapter   6 of the Military Rehabilitation and Compensation Act 2004 ;

  (c)   the Safety, Rehabilitation and Compensation (Defence - related Claims) Act 1988 ;

  (d)   the Treatment Benefits (Special Access) Act 2019;

  (e)   Part   V of the Veterans' Entitlements Act 1986 ;

  (f)   any other Commonwealth law prescribed by the regulations for the purposes of this paragraph.

"review period" , in relation to:

  (a)   a request by the Chief Executive Medicare under section   86 (the initial request ); or

  (b)   a Director's review arising from the initial request; or

  (c)   a Committee investigation arising from the Director's review; or

  (d)   a request by a Committee under subsection   106J(1) arising from the Committee investigation;

means the period specified in the initial request.

"service" means:

  (a)   a service that has been rendered if, at the time it was rendered, medicare benefit or dental benefit was payable in respect of the service; or

  (ab)   a service that has been initiated (whether or not it has been or will be rendered) if, at the time it was initiated, medicare benefit would have been payable in respect of the service had it been rendered at that time; or

  (b)   a service rendered by way of a prescribing or supply of a pharmaceutical benefit by a medical practitioner, a dental practitioner, an optometrist, a midwife or a nurse practitioner; or

  (c)   a service that:

  (i)   has been rendered in connection with the provision of treatment under a relevant DVA law; and

  (ii)   is of a kind that, if the service had not been rendered in connection with the provision of treatment under the relevant DVA law, medicare benefit or dental benefit would have been payable in respect of the service.

Note 1:   See Part   II, and in particular section   10, for when a medicare benefit is payable.

Note 2:   See the Dental Benefits Act 2008 for when a dental benefit is payable.

"specialist" , in relation to a particular specialty, includes (except for the purposes of section   95) a consultant physician in that specialty.

Practitioners and professions determined by Minister

  (1A)   The Minister may, by legislative instrument, determine:

  (a)   that a health professional of a particular kind (being a health professional who provides a health service within the meaning of subsection   3C(8)) is a practitioner for the purposes of this Part; and

  (b)   that a vocation engaged in by a health professional of a kind determined under this subsection is a profession for the purposes of this Part.

Meaning of provides services

  (2)   For the purposes of this Part, a person provides services if the services are rendered or initiated by:

  (a)   the person; or

  (b)   a practitioner employed or otherwise engaged by the person; or

  (c)   a practitioner employed or otherwise engaged by a body corporate of which the person is an officer.


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