Commonwealth Numbered Regulations - Explanatory Statements

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HEALTH INSURANCE COMMISSION REGULATIONS (AMENDMENT) 1994 NO. 257

STATUTORY RULES 1994 No. 257

Issued by the authority of the Minister for Human Services and Health

Health Insurance Commission Act 1973

Health Insurance Commission Regulations (Amendment)

The Health Insurance Commission Act 1973 (the Act) provides for the constitution of a Health Insurance Commission (the Commission) and for purposes connected therewith.

Section 44 of the Act provides that the Governor-General may make regulations for the purposes of the Act.

Section 8E of the Act requires the Commission to perform such functions in relation to health and health insurance as are prescribed.

The new Regulations amend the Health Insurance Commission Regulations (the Regulations) in consequence of amendments made to the Health Insurance Act 1973 establishing the Professional Services Review Scheme from 1 July 1994.

The Review Scheme provides for the establishment of Professional Services Review Committees to review the conduct of practitioners (doctors, dentists, optometrists, chiropractors, physiotherapists and podiatrists) in connection with the rendering or initiating of services under Medicare to determine if the practitioner under review has engaged in inappropriate practice.

The Professional Services Review Scheme replaces Committees of Inquiry which consider whether a medical practitioner, a dental practitioner or an optometrist has rendered excessive services under Medicare.

Under the Professional Services Review Scheme, the Commission is responsible for referring to an independent Director of Professional Services Review practitioners suspected of having engaged in inappropriate practice.

Regulation 2 makes investigations related to inappropriate practice functions of the Commission.

Subregulation 2.1 specifies that the definitions listed in Regulation 2 have the same meaning as those in Part VAA (The Professional Services Review Scheme) of the Health Insurance Act 1973.

Subregulation 2.2 prescribes as Commission functions the prevention and detection of inappropriate practice.

Subregulation 2.3 prescribes as a Commission function the investigation of the conduct of a person suspected, on reasonable grounds, to have engaged in inappropriate practice for the purpose of making a referral to the Director of Professional Services Review.

Subregulations 2.4 and 2.5 delete references to supplanted committees.

Regulation 3 deletes a number of obsolete provisions.

Regulation 4 provides that the Commission retains .its functions in relation to matters referred to Committees of Inquiry before 1 July 1994 until those matters have been concluded.

The Regulations commence on gazettal.