Commonwealth Consolidated Regulations Commonwealth Consolidated Regulationsmade under the
Compilation No. 21
Compilation date: 1 November 2024
Includes amendments: F2024L01219
About this compilation
This compilation
This is a compilation of the Health Insurance Regulations 2018 that shows the text of the law as amended and in force on 1 November 2024 (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 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 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 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If a provision of the compiled law has been repealed in accordance with a provision of the law, details are included in the endnotes.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--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
1 Organisations, specialties and qualifications
Endnotes
Endnote 1--About the endnotes
Endnote 2--Abbreviation key
Endnote 3--Legislation history
Endnote 4--Amendment history
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 how an amendment is to be made. If, despite the misdescription, the amendment can be given effect as intended, then the misdescribed amendment can be incorporated through an editorial change made under section 15V of the Legislation Act 2003.
If a misdescribed amendment cannot be given effect as intended, the amendment is not incorporated and "(md not incorp)" is added to the amendment history.
ad = added or inserted | o = order(s) |
am = amended | Ord = Ordinance |
amdt = amendment | orig = original |
c = clause(s) | par = paragraph(s)/subparagraph(s) |
C[x] = Compilation No. x | /sub-subparagraph(s) |
Ch = Chapter(s) | pres = present |
def = definition(s) | prev = previous |
Dict = Dictionary | (prev ... ) = previously |
disallowed = disallowed by Parliament | Pt = Part(s) |
Div = Division(s) | r = regulation(s)/rule(s) |
ed = editorial change | reloc = relocated |
exp = expires/expired or ceases/ceased to have | renum = renumbered |
effect | rep = repealed |
F = Federal Register of Legislation | rs = repealed and substituted |
gaz = gazette | s = section(s)/subsection(s) |
LA = Legislation Act 2003 | Sch = Schedule(s) |
Sdiv = Subdivision(s) | |
(md) = misdescribed amendment can be given | SLI = Select Legislative Instrument |
effect | SR = Statutory Rules |
(md not incorp) = misdescribed amendment | Sub-Ch = Sub-Chapter(s) |
cannot be given effect | SubPt = Subpart(s) |
mod = modified/modification | underlining = whole or part not |
No. = Number(s) | commenced or to be commenced |
Endnote 3--Legislation history
Name | Registration | Commencement | Application, saving and transitional provisions |
27 Sept 2018 (F2018L01365) | 1 Oct 2018 (s 2(1) item 1) |
| |
Health Insurance Legislation Amendment (2018 Measures No. 3) Regulations 2018 | 26 Oct 2018 (F2018L01481) | Sch 1 (items 108-113): 1 Nov 2018 (s 2(1) item 1) | -- |
Health Insurance Legislation Amendment (2018 Measures No. 4) Regulations 2018 | 5 Nov 2018 (F2018L01534) | Sch 1 (item 1): 1 Jan 2019 (s 2(1) item 1) | -- |
Health Insurance Legislation Amendment (Services for Patients in Residential Aged Care Facilities) Regulations 2019 | 22 Feb 2019 (F2019L00179) | Sch 1 (items 10-14): 1 Mar 2019 (s 2(1) item 1) | -- |
Health Insurance Legislation Amendment (2019 Measures No. 1) Regulations 2019 | 24 Sept 2019 (F2019L01256) | Sch 1 (items 77-81): 1 Nov 2019 (s 2(1) item 2) | -- |
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) | -- |
Health Insurance Amendment (General Practitioners) Regulations 2020 | 26 June 2020 (F2020L00794) | Sch 1 (items 1-4): 27 June 2020 (s 2(1) item 2) | -- |
Health Insurance Legislation Amendment (2020 Measures No. 3) Regulations 2020 | 14 Dec 2020 (F2020L01608) | Sch 1 (item 97): 1 Mar 2021 (s 2(1) item 4) | -- |
Health Insurance Amendment (Fees) Regulations 2021 | 28 June 2021 (F2021L00870) | 1 July 2021 (s 2(1) item 1) | -- |
Health Insurance Legislation Amendment (2021 Measures No. 4) Regulations 2021 | 17 Dec 2021 (F2021L01812) | Sch 1 (item 128): 1 Mar 2022 (s 2(1) item 1) | -- |
Health Insurance Legislation Amendment (2022 Measures No. 2) Regulations 2022 | 21 July 2022 (F2022L01000) | Sch 1 (item 12): 1 Aug 2022 (s 2(1) item 1) | -- |
Health Insurance Legislation Amendment (2022 Measures No. 3) Regulations 2022 | 22 Aug 2022 (F2022L01099) | Sch 4: 1 Nov 2022 (s 2(1) item 2) | -- |
Health Insurance Legislation Amendment (2022 Measures No. 4) Regulations 2022 | 25 Nov 2022 (F2022L01518) | Sch 1 (items 148-150): 1 Mar 2023 (s 2(1) item 1) | -- |
Health Insurance Legislation Amendment (2023 Measures No. 1) Regulations 2023 | 4 Apr 2023 (F2023L00416) | Sch 5 (items 11, 12): 1 July 2023 (s 2(1) item 6) | -- |
Health Insurance Amendment (Workforce Programs) Regulations 2023 | 13 June 2023 (F2023L00780) | 1 July 2023 (s 2(1) item 1) | -- |
Health Insurance Legislation Amendment (2023 Measures No. 3) Regulations 2023 | 16 Oct 2023 (F2023L01386) | Sch 7: 1 Nov 2023 (s 2(1) item 4) | -- |
Statute Law Amendment (Prescribed Forms) Regulations 2024 | 15 Mar 2024 (F2024L00294) | Sch 1 (items 24, 25): 20 Mar 2024 (s 2(1) item 1) | -- |
Health Insurance Amendment (Workforce Programs) Regulations 2024 | 20 Mar 2024 (F2024L00334) | 21 Mar 2024 (s 2(1) item 1) | -- |
Health Insurance Legislation Amendment (2024 Measures No. 3) Regulations 2024 | 23 May 2024 (F2024L00576) | Sch 1 (items 11-17): 1 July 2024 (s 2(1) item 1) | -- |
Health Insurance Legislation Amendment (2024 Measures No. 4) Regulations 2024 | 26 Sept 2024 (F2024L01219) | Sch 4 (items 1-4): 1 Nov 2024 (s 2(1) item 1) | -- |
Provision affected | How affected |
Part 1 |
|
s 2..................... | rep LA s 48D |
s 4..................... | am F2020L00294; F2020L00794; F2024L01219 |
Part 2 |
|
Division 1................ | rep F2024L01219 |
s 5..................... | rep F2024L01219 |
s 6..................... | rep F2024L01219 |
Division 2................ | rep F2024L01219 |
s 7..................... | rep F2024L01219 |
s 8..................... | rep F2024L01219 |
Division 3 |
|
s 11.................... | am F2020L00458 |
Division 4 |
|
s 14.................... | rep F2021L00870 |
s 15.................... | rep F2021L00870 |
Division 5 |
|
Division 5................ | rs F2020L00794 |
Subdivision A............. | rep F2020L00794 |
s 16.................... | rs F2020L00794 |
s 17.................... | rep F2020L00794 |
s 18.................... | rep F2020L00794 |
Subdivision B.............. | rs F2020L00794 |
| rep F2020L00794 |
s 19.................... | rs F2020L00794 |
| rep F2020L00794 |
s 19A................... | ad F2020L00794 |
| rep F2020L00794 |
s 20.................... | rs F2020L00794 |
| rep F2020L00794 |
s 21.................... | rs F2020L00794 |
| rep F2020L00794 |
s 21A................... | ad F2020L00794 |
| rep F2020L00794 |
Subdivision C.............. | rep F2020L00794 |
s 22.................... | rep F2020L00794 |
s 23.................... | rep F2020L00794 |
s 24.................... | rep F2020L00794 |
Subdivision D............. | rep F2020L00794 |
s 25.................... | rep F2020L00794 |
Division 6 |
|
s 26.................... | am F2018L01534; F2023L00780; F2024L00334 |
s 27.................... | am F2020L00794 |
Part 3 |
|
Division 1 |
|
s 28.................... | am F2018L01481; F2019L00179; F2019L01256; F2020L00458; F2020L01608; F2021L01812; F2022L01000; F2022L01099; F2022L01518; F2023L00416; F2023L01386 |
Division 3 |
|
Subdivision B |
|
s 39.................... | am F2018L01481; F2020L00458; F2022L01099 |
s 40.................... | am F2020L00458 |
s 41.................... | am F2020L00458 |
s 42.................... | am F2018L01481; F2020L00458 |
s 43.................... | am F2020L00458 |
s 44.................... | am F2018L01481; F2020L00458; F2024L01219 |
Subdivision C |
|
s 45.................... | am F2020L00458 |
Division 4 |
|
s 46.................... | am F2024L00576 |
Division 5 |
|
s 51.................... | am F2024L00576 |
s 52.................... | am F2024L00576 |
s 60.................... | am F2020L00458 |
Division 7 |
|
s 63.................... | am F2020L00794 |
Part 5 |
|
s 74.................... | am F2020L00458 |
Part 7 |
|
s 80.................... | am F2024L00576 |
Part 8 |
|
s 81.................... | rs F2024L00294 |
s 82.................... | rs F2024L00294 |
Part 11 |
|
Division 3 |
|
s 92.................... | am F2020L00294 |
s 93.................... | am F2020L00294 |
Part 12 |
|
Part 12 heading............. | rs F2020L00794 |
Division 2................ | ad F2020L00794 |
| rep F2020L00794 |
s 104................... | ad F2020L00794 |
| rep F2020L00794 |
Schedule 2................ | rep F2024L00294 |