Commonwealth Consolidated Regulations

HEALTH INSURANCE REGULATIONS 2018

- made under the Health Insurance Act 1973

TABLE OF PROVISIONS

   PART 1--PRELIMINARY

   1.      Name  
   3.      Authority  
   4.      Definitions  

   PART 2--DEFINITIONAL--MATERIAL

           Division 3--Definition of services

   9.      Professional services--medical services rendered by approved dental practitioners  
   10.     Meaning of specialist trainee  
   11.     Professional services rendered by specialist trainees  
   12.     Health service not specified in an item--meaning of health service  

           Division 4--Recognition of medical practitioners as specialists and consultant physicians

   13.     Recognition of medical practitioner domiciled in Australia as specialist--meaning of relevant organisation and relevant qualification  

           Division 5--General practitioners

   16.     Medical practitioners who were on Vocational Register of General Practitioners  

           Division 6--Register of Approved Placements

   26.     Specified bodies, courses and programs  
   27.     Removal from the Register  

   PART 3--MEDICARE--BENEFITS

           Division 1--Amount of medicare benefit

   28.     Entitlement to medicare benefit--services for which medicare benefit is 100% of Schedule fee  

           Division 2--Medicare benefits in relation to pathology services

              Subdivision A--Simplified outline of this Division

   29.     Simplified outline of this Division  

              Subdivision B--Specifying services

   30.     Pathology service determined to be necessary by participating midwife  
   31.     Pathology service determined to be necessary by participating nurse practitioner  

              Subdivision C--Requirements for requests for pathology services

   32.     Purpose of Subdivision  
   33.     Information about requesting practitioner  
   34.     Information about patient  
   35.     Information about pathology service  
   36.     Requests that specify an approved pathology practitioner  
   37.     Further requests  

           Division 3--Medicare benefits in relation to R-type diagnostic imaging services

              Subdivision A--Simplified outline of this Division

   38.     Simplified outline of this Division  

              Subdivision B--Specifying services for effective requests

   39.     Requests by dental practitioners  
   40.     Requests by chiropractors  
   41.     Requests by physiotherapists or osteopaths  
   42.     Requests by podiatrists  
   43.     Requests by participating midwives  
   44.     Requests by participating nurse practitioners  

              Subdivision C--Specifying services for pre-existing diagnostic imaging practices

   45.     Exemption from subsection 16B(1) of the Act--pre - existing diagnostic imaging practices  

           Division 4--Medicare benefits in relation to radiation oncology services

   46.     Meaning of radiation oncology service  

           Division 5--Particulars of professional services

   47.     Simplified outline of this Division  
   48.     Purpose of Division  
   49.     All services--particulars of patient, date of service and fees  
   50.     All services--particulars of professional service rendered  
   51.     Most general medical services and Group P9 pathology services--particulars of person rendering service  
   52.     Certain radiation or nuclear services--particulars of person rendering service and person claiming or receiving fees  
   53.     Certain radiation oncology services--use of equipment  
   54.     Pathology services (other than Group P9)--particulars of person rendering service  
   55.     Pathology services--other particulars  
   56.     Diagnostic imaging services--particulars of person rendering service and person claiming or receiving fees  
   57.     Diagnostic imaging services--other particulars  
   58.     Services provided upon referral  
   59.     Multiple professional services in a single day  
   60.     Anaesthesia  

           Division 6--Professional services rendered by or on behalf of certain medical practitioners

   61.     Other circumstances in which subparagraphs 19AA(1)(b)(iv) and (2)(b)(iv) of the Act apply  
   62.     Meaning of intern  

           Division 7--Payments to medical practitioners and approved billing agents

   63.     Circumstances for electronic payments to medical practitioners  
   64.     Requirements for payments to specialists and consultant physicians  
   65.     Approved billing agents--application requirements and fee  

           Division 8--Eligible midwives

   66.     Meaning of eligible midwife --requirements  

   PART 4--SPECIAL--PROVISIONS RELATING TO PATHOLOGY

   67.     Giving notice of termination of undertaking  
   68.     Approved pathology authorities--other records of pathology services  
   69.     Offences in relation to request forms--branded pathology request forms  

   PART 5--SPECIAL--PROVISIONS RELATING TO DIAGNOSTIC IMAGING SERVICES

   70.     Requests for diagnostic imaging services--information and form requirements  
   71.     Medical practitioners rendering diagnostic imaging services--other records of services  
   72.     Diagnostic Imaging Register--other information to be included in application for registration  
   73.     Diagnostic Imaging Register--other information to be included on Register  
   74.     Primary information--types of diagnostic imaging equipment  
   75.     Diagnostic imaging accreditation--information to be included on Diagnostic Imaging Register  

   PART 6--PROHIBITED--PRACTICES IN RELATION TO PATHOLOGY SERVICES AND DIAGNOSTIC IMAGING SERVICES

   76.     Meaning of permitted benefit --method for determining substantial difference from market value  
   77.     Meaning of permitted benefit --method for determining market value  

   PART 7--RADIATION--ONCOLOGY REGISTER

   78.     Radiation Oncology Register--other information to be included in application for registration  
   79.     Radiation Oncology Register--other information to be included on the Register  
   80.     Primary information--types of radiation oncology equipment  

   PART 8--HEALTH--PROGRAM GRANTS

   81.     Application for approval as an organization under Part IV of the Act  
   82.     Application for approval of health service under Part IV of the Act  

   PART 9--MEDICARE--PARTICIPATION REVIEW COMMITTEES

   83.     Meaning of professional organisation  

   PART 10--QUALITY--ASSURANCE CONFIDENTIALITY

           Division 1--Quality assurance activities--application for declaration

   84.     Application for declaration that quality assurance activity is activity to which Part VC of the Act applies  

           Division 2--Quality assurance activities--public interest criteria

   85.     Purpose of Division  
   86.     Disclosure of information about quality assurance activities  
   87.     Quality assurance activities engaged in in a single State or Territory  
   88.     Quality assurance activities of a kind that has not previously been engaged in in Australia  
   89.     Quality assurance activities of a kind that has previously been engaged in in Australia  

   PART 11--MISCELLANEOUS--PROVISIONS

           Division 1--Charging of fees for provision of public hospital services to public patients

   90.     Circumstances in which fees must not be charged for provision of public hospital services to public patients  

           Division 2--Recovery of amounts

   91.     Recovery of debts due to the Commonwealth--prescribed rate of interest  

           Division 3--Divulging and using information

   92.     Divulging information--treatment provided to veterans  
   93.     Divulging information--complaints and investigations  
   94.     Professional disciplinary and regulatory bodies  

           Division 4--Manner of patient referrals

   95.     Purpose and application of Division  
   96.     Who can make referral  
   97.     Requirement to consider need for referral  
   98.     Requirements for form of referral  
   99.     Requirements for contents of referral  
   100.    Requirement to record certain referrals in hospital records  
   101.    Receipt of referral by specialist or consultant physician  
   102.    Period of validity for referrals  

   PART 12--APPLICATION--, SAVING AND TRANSITIONAL PROVISIONS

           Division 1--Transitional matters relating to the repeal of the Health Insurance Regulations 1975

   103.    Things done under the Health Insurance Regulations 1975  
           SCHEDULE 1 Specialists