{"id":"C2012A00076","name":"Health Insurance Amendment (Professional Services Review) Act 2012","slug":"health-insurance-amendment-professional-services-review-act-2012","collection":"act","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":"76 of 2012","makingDate":null,"administeringDepartment":null,"currentVersion":{"id":8397,"registerId":"commonwealth-C2012A00076-current","compilationNumber":null,"startDate":"2026-03-30","status":"InForce","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"1","sectionType":"section","heading":"Health Insurance Amendment (Professional Services Review) Act 2012","content":"---\nmeta-content-style-type: text/css\nmeta-content-type: application/xhtml+xml; charset=utf-8\n---\n\n?xml version=\"1.0\" encoding=\"utf-8\" standalone=\"no\"?>\n\n![](image.001.png)\n\n \n\n \n\n \n\n \n\n \n\n \n\nHealth Insurance Amendment (Professional Services Review) Act 2012\n\n \n\nNo. 76, 2012\n\n \n\n \n\n \n\n \n\n \n\nAn Act to validate certain actions under Part VAA, VB or VII of the Health Insurance Act 1973, and to amend that Act, and for related purposes\n\n \n\n \n\nContents\n\n1 Short title\n\n2 Commencement\n\n3 Schedule(s)\n\nSchedule 1—Validation of certain acts\n\nSchedule 2—Amendments relating to the Professional Services Review Scheme\n\nPart 1—Prescribed pattern of services\n\nHealth Insurance Act 1973\n\nPart 2—Allied health practitioners\n\nDivision 1—Amendments\n\nHealth Insurance Act 1973\n\nDivision 2—Transitional and application provisions\n\nPart 3—Meaning of service\n\nHealth Insurance Act 1973\n\nPart 4—Extension of time for certain processes\n\nHealth Insurance Act 1973\n\nPart 5—No further action to be taken in certain circumstances\n\nHealth Insurance Act 1973\n\nPart 6—Date of effect for final determinations\n\nHealth Insurance Act 1973\n\nPart 7—Referrals to Medicare Participation Review Committee\n\nHealth Insurance Act 1973\n\nPart 8—Referrals to appropriate regulatory bodies\n\nHealth Insurance Act 1973\n\nPart 9—Disqualified practitioners\n\nHealth Insurance Act 1973\n\nPart 10—Patient referrals\n\nHealth Insurance Act 1973\n\nSchedule 3—Technical amendments relating to legislative instruments\n\nHealth Insurance Act 1973\n\n \n\n![](image.001.png)\n\n \n\n \n\nHealth Insurance Amendment (Professional Services Review) Act 2012\n\nNo. 76, 2012\n\n \n\n \n\n \n\nAn Act to validate certain actions under Part VAA, VB or VII of the Health Insurance Act 1973, and to amend that Act, and for related purposes\n\n[Assented to 27 June 2012]\n\nThe Parliament of Australia enacts:\n\n1  Short title\n\n  This Act may be cited as the Health Insurance Amendment (Professional Services Review) Act 2012.\n\n2  Commencement\n\n (1) Each provision of this Act specified in column 1 of the table commences, or is taken to have commenced, in accordance with column 2 of the table. Any other statement in column 2 has effect according to its terms.\n\n \n\n- Commencement information\n- Column 1 Column 2 Column 3\n- Provision(s) Commencement Date/Details\n- 1. Sections 1 to 3 and anything in this Act not elsewhere covered by this table The day this Act receives the Royal Assent. 27 June 2012\n- 2. Schedule 1 The day this Act receives the Royal Assent. 27 June 2012\n- 3. Schedule 2 A single day to be fixed by Proclamation.However, if the provision(s) do not commence within the period of 6 months beginning on the day this Act receives the Royal Assent, they commence on the day after the end of that period. 27 December 2012\n- 4. Schedule 3 The day after this Act receives the Royal Assent. 28 June 2012\n\n\nNote:  This table relates only to the provisions of this Act as originally enacted. It will not be amended to deal with any later amendments of this Act.\n\n (2) Any information in column 3 of the table is not part of this Act. Information may be inserted in this column, or information in it may be edited, in any published version of this Act.\n\n3  Schedule(s)\n\n  Each Act that is specified in a Schedule to this Act is amended or repealed as set out in the applicable items in the Schedule concerned, and any other item in a Schedule to this Act has effect according to its terms.\n\n\n\n\nSchedule 1—Validation of certain acts\n\n \n\n1  Validation of acts done under Part VAA, VB or VII of the Health Insurance Act 1973\n\n(1) This item applies to a thing purportedly done under Part VAA, VB or VII of the Health Insurance Act 1973 at any time before the day this item commences, to the extent that the thing purportedly done would, apart from this item, be invalid because a person was not appointed or validly appointed as a Panel member or Deputy Director under Part VAA of that Act.\n\n(2) The thing purportedly done is as valid and effective, and is taken always to have been as valid and effective, as it would have been had the person been validly appointed as a Panel member or Deputy Director under that Part.\n\n(3) All persons are, by force of this subitem, declared to be, and always to have been, entitled to act on the basis that the thing purportedly done is valid and effective.\n\n(4) This item does not affect rights or liabilities of parties to proceedings for which leave to appeal to the High Court of Australia has been given on or before the day this item commences, if the fact that a person was not appointed or validly appointed as a Panel member or Deputy Director under that Part is in issue in the proceedings.\n\n(5) Subject to subitem (4), subitems (1), (2) and (3) have effect in relation to:\n\n (a) proceedings (whether original or appellate) that begin on or after the day this item commences; and\n\n (b) proceedings (whether original or appellate) that began before the day this item commences, being proceedings that had not been finally determined as at that day.\n\n2  Re‑referral to a Committee allowed in certain cases\n\n(1) This item applies if:\n\n (a) proceedings relating to Part VAA of the Health Insurance Act 1973 were brought before the day this item commences; and\n\n (b) those proceedings are finally determined, or otherwise disposed of (before or after the day this item commences), in favour of the person under review on the grounds that, or on grounds that include the ground that, a person was not appointed or validly appointed as a Panel member or Deputy Director under that Part.\n\n(2) Despite section 94 of the Health Insurance Act 1973, before the end of 12 months after the proceedings are finally determined, or otherwise disposed of, the Director may, by writing, set up a Committee in accordance with Division 4 of Part VAA of that Act, and make a referral to the Committee in accordance with section 93 of that Act in relation to the services provided by the person that were the subject of the proceedings.\n\n(3) If subitem (2) applies, the Committee may take into account:\n\n (a) evidence given in relation to the review as investigated before proceedings were brought; and\n\n (b) evidence given in the proceedings, as mentioned in subitem (1).\n\n(4) To avoid doubt, subitem (3) does not limit the evidence that the Committee may take into account.\n\n3  Compensation for acquisition of property\n\n(1) If the operation of this Schedule would result in an acquisition of property from a person otherwise than on just terms, the Commonwealth is liable to pay a reasonable amount of compensation to the person.\n\n(2) If the Commonwealth and the person do not agree on the amount of the compensation, the person may institute proceedings in a court of competent jurisdiction for the recovery from the Commonwealth of such reasonable amount of compensation as the court determines.\n\n(3) In this item:\n\nacquisition of property has the same meaning as in paragraph 51(xxxi) of the Constitution.\n\njust terms has the same meaning as in paragraph 51(xxxi) of the Constitution.\n\n\n\n\nSchedule 2—Amendments relating to the Professional Services Review Scheme\n\nPart 1—Prescribed pattern of services\n\nHealth Insurance Act 1973\n\n1  Subsection 81(1)\n\nInsert:\n\nprescribed pattern of services has the meaning given by section 82A.\n\n2  Before subsection 82(1)\n\nInsert:\n\nUnacceptable conduct\n\n3  After subsection 82(1)\n\nInsert:\n\nPrescribed pattern of services\n\n (1A) Subject to subsections (1B) and (1C), a practitioner engages in inappropriate practice in rendering or initiating services during a particular period (the relevant period) if the circumstances in which some or all of the services were rendered or initiated constitute a prescribed pattern of services.\n\n (1B) A practitioner does not, under subsection (1A), engage in inappropriate practice in rendering or initiating services on a particular day during the relevant period if a Committee could reasonably conclude that, on that day, exceptional circumstances existed that affected the rendering or initiating of the services.\n\n (1C) Subsection (1B) does not affect the operation of subsection (1A) in respect of the remaining day or days during the relevant period on which the practitioner rendered or initiated services even if the circumstances in which the services were rendered or initiated on that day or those days would not, if considered alone, have constituted a prescribed pattern of services.\n\n (1D) The circumstances that constitute exceptional circumstances for the purposes of subsection (1B) include, but are not limited to, circumstances that are prescribed by the regulations to be exceptional circumstances.\n\nCausing or permitting inappropriate practice\n\n4  Paragraphs 82(2)(a) and (b)\n\nOmit “within the meaning of subsection (1)”, substitute “under subsection (1) or (1A)”.\n\n5  Before subsection 82(3)\n\nInsert:\n\nMatters to which Committee must have regard\n\n6  At the end of Division 1 of Part VAA\n\nAdd:\n\n82A  Meaning of prescribed pattern of services\n\n (1) The circumstances in which services are rendered or initiated by a practitioner constitute a prescribed pattern of services if they are circumstances prescribed by the regulations for the purposes of this section.\n\n (2) The circumstances prescribed may relate to services of a particular kind or description that are rendered or initiated by:\n\n (a) practitioners in a particular profession; or\n\n (b) an identified group or groups of practitioners in a particular profession.\n\n (3) The circumstances prescribed may include the rendering or initiation of more than a specified number of services, or more than a specified number of services of a particular kind, on each of more than a specified number of days during a period of a specified duration.\n\n7  Division 3 of Part VAA (heading)\n\nRepeal the heading, substitute:\n\nDivision 3—Role of Chief Executive Medicare\n\n8  Section 86 (heading)\n\nRepeal the heading, substitute:\n\n86  Requests by Chief Executive Medicare to Director to review provision of services\n\n9  Subsection 86(1)\n\nOmit “The”, substitute “Subject to subsection (1A), the”.\n\n10  After subsection 86(1)\n\nInsert:\n\n (1A) If the Chief Executive Medicare becomes aware that the circumstances in which services were rendered or initiated by a person constitute a prescribed pattern of services, the Chief Executive Medicare must make a request under subsection (1) in relation to the services.\n\n11  At the end of subsection 86(3)\n\nAdd:\n\nNote: If the request is made because of subsection (1A), it may include reasons other than the prescribed pattern of services.\n\n12  At the end of subsection 93(6)\n\nAdd:\n\nNote: The reasons given by the Director may relate solely to the services being rendered or initiated in circumstances that constitute a prescribed pattern of services.\n\n13  Section 106KA\n\nRepeal the section.\n\n14  Paragraph 106KB(1)(b)\n\nOmit “106KA”, substitute “for the purposes of subsection 82(1A) or (1B)”.\n\n15  Application\n\n(1) Despite the repeals and amendments of the Health Insurance Act 1973 made by this Part, the old law continues to apply, in relation to a request to review the provision of services by a person that was made under section 86 of that Act before the commencement day, as if those repeals and amendments had not happened.\n\n(2) In this item:\n\ncommencement day means the day this item commences.\n\nold law means:\n\n (a) section 106KA of the Health Insurance Act 1973, as in force immediately before the commencement day; and\n\n (b) any regulations made for the purposes of that section that were in force immediately before the commencement day; and\n\n (c) section 106KB of that Act, as in force immediately before the commencement day.\n\n\n\n\nPart 2—Allied health practitioners\n\nDivision 1—Amendments\n\nHealth Insurance Act 1973\n\n16  Subsection 81(1) (at the end of the definition of practitioner)\n\nAdd:\n\n ; 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.\n\n17  Subsection 81(1) (at the end of the definition of profession)\n\nAdd:\n\n ; (h) a vocation determined by the Minister under subsection (1A) to be a profession for the purposes of this Part.\n\n18  After subsection 81(1)\n\nInsert:\n\nPractitioners and professions determined by Minister\n\n (1A) The Minister may, by legislative instrument, determine:\n\n (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\n\n (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.\n\n19  Before subsection 81(2)\n\nInsert:\n\nMeaning of provides services\n\n20  Paragraph 106ZPA(1)(c)\n\nRepeal the paragraph, substitute:\n\n (c) other members, of whom there is to be one of each kind of practitioner in relation to which the Professional Services Review Scheme established by this Part applies.\n\nNote: See subsection 81(1) for the definition of practitioner.\n\n21  Paragraph 106ZPB(2)(c)\n\nRepeal the paragraph, substitute:\n\n (c) appoint a medical practitioner as a member of the Authority referred to in paragraph 106ZPA(1)(c);\n\n22  Subsection 106ZPB(3)\n\nAfter “a practitioner”, insert “(other than a medical practitioner)”.\n\n23  Subsection 106ZPB(3)\n\nOmit “any of subparagraphs 106ZPA(1)(c)(ii) to (vii)”, substitute “paragraph 106ZPA(1)(c)”.\n\n24  Subsection 106ZPH(3)\n\nRepeal the subsection, substitute:\n\n (3) The Minister must not appoint a person to act in an office of a member (the relevant member) of the Authority referred to in paragraph 106ZPA(1)(c) unless the person is a practitioner of the same kind as the relevant member.\n\n25  Subsection 124B(1) (at the end of the definition of practitioner)\n\nAdd:\n\n ; or (i) a health professional of a kind determined by the Minister under subsection (7) to be a practitioner for the purposes of this Part.\n\n26  At the end of section 124B\n\nAdd:\n\n (7) The Minister may, by legislative instrument, determine 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.\n\n27  At the end of subsection 124EB(2)\n\nAdd:\n\n ; or (d) if the Committee is convened in relation to a chiropractor—a chiropractor; or\n\n (e) if the Committee is convened in relation to a physiotherapist—a physiotherapist; or\n\n (f) if the Committee is convened in relation to a podiatrist—a podiatrist; or\n\n (g) if the Committee is convened in relation to an osteopath—an osteopath; or\n\n (h) if the Committee is convened in relation to a person who is a health professional of a kind covered by paragraph (i) of the definition of practitioner in subsection 124B(1)—a health professional of the same kind as the person.\n\nDivision 2—Transitional and application provisions\n\n28  Transitional—review of services rendered or initiated by certain allied health practitioners\n\nThe Chief Executive Medicare must not make a request under section 86 of the Health Insurance Act 1973 to review the provision of services by a person during a period if:\n\n (a) the services were rendered or initiated by a health professional who is a practitioner for the purposes of Part VAA of that Act because of a determination that is in force under subsection 81(1A) of that Act (as inserted by item 18 of this Schedule); and\n\n (b) the period falls before the determination took effect.\n\n29  Application—acts and omissions of certain allied health practitioners\n\n(1) This item applies in relation to a person who is a practitioner for the purposes of Part VB of the Health Insurance Act 1973 because of a determination that is in force under subsection 124B(7) of that Act (as inserted by item 26 of this Schedule).\n\n(2) Part VB of the Health Insurance Act 1973 does not apply in relation to acts and omissions of the person that took place before the determination took effect.\n\n(3) For the purposes of this item, if an act or omission is alleged to have taken place between 2 dates, one before and one on or after the day the determination took effect, the act or omission is alleged to have taken place before the determination took effect.\n\n30  Application of item 27\n\nThe amendment of the Health Insurance Act 1973 made by item 27 of this Schedule does not apply in relation to a Committee that was established under subsection 124E(1) of that Act before the day this item commences.\n\n\n\n\nPart 3—Meaning of service\n\nHealth Insurance Act 1973\n\n31  Subsection 81(1) (paragraph (a) of the definition of service)\n\nRepeal the paragraph, substitute:\n\n (a) a service that has been rendered if, at the time it was rendered, medicare benefit was payable in respect of the service; or\n\n (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\n\n32  Application\n\nThe amendment made by this Part applies to a service that is rendered or initiated on or after the day this item commences.\n\n\n\n\nPart 4—Extension of time for certain processes\n\nHealth Insurance Act 1973\n\n33  Subsection 106G(3)\n\nRepeal the subsection, substitute:\n\n (3) If a circumstance specified in column 1 of an item in the following table occurs, the Committee may determine, in writing, that the period of 6 months referred to in paragraph (2)(a) is extended for a period not exceeding the period specified in column 2 of that item.\n\n \n\n- Extension of period for giving final report\n- Item Column 1Circumstance Column 2Period\n- 1 The person under review is unable because of illness to attend a hearing being conducted by the Committee The period during which the person under review is unable to attend the hearing\n- 2 The person under review is fully disqualified under section 105 The period during which the person under review is fully disqualified under that section\n- 3 A notice is given to a person under subsection 105A(2) and the person fails to comply with a requirement of the notice The period during which the person to whom the notice is given fails to comply with the requirement\n- 4 The Committee’s consideration of the referral is suspended under paragraph 106N(2)(b) or because of an injunction or other court order The period for which the Committee’s consideration of the referral is suspended\n\n\n \n\n34  After subsection 106G(4)\n\nInsert:\n\n (4A) The period of 6 months referred to in paragraph (2)(a) may be extended under subsection (3) more than once.\n\n35  Subsection 106S(2)\n\nRepeal the subsection, substitute:\n\n (2) The Director may give information to the Determining Authority under subsection (1) on one occasion only.\n\n (2A) The Director must not give information to the Determining Authority under subsection (1) after the Authority has made its draft determination in accordance with section 106U.\n\n36  Section 106SA\n\nRepeal the section, substitute:\n\n106SA  Authority to invite submissions before making a draft determination\n\nInvitation to make submissions\n\n (1) The Determining Authority must give the person under review a written invitation to make written submissions to the Authority, having regard to the Committee’s final report and any information given by the Director under section 106S, about the directions the Authority should make in the draft determination relating to the person.\n\nNote: Section 106U sets out the directions the Authority can make.\n\n (2) An invitation under subsection (1) must state that the person under review may make submissions within 1 month after the day on which the invitation is given to the person.\n\nNote: The period for making submissions may be extended under subsection (5) and may be affected by section 106TB.\n\nInvitation to be given after Committee’s final report is given to Authority\n\n (3) The Determining Authority must give an invitation under subsection (1) within 1 month after being given the Committee’s final report.\n\nNote: The period for giving the invitation may be affected by section 106TB.\n\nFurther invitation to be given in certain circumstances\n\n (4) If the Director gives the Determining Authority information under section 106S after the Authority has given the person under review an invitation under subsection (1), the Authority must, within 14 days after being given the information, give the person a further invitation under subsection (1). Subsection (3) does not apply to the further invitation.\n\nNote: The period for giving the further invitation may be affected by section 106TB.\n\nPeriod for making submissions may be extended\n\n (5) The Determining Authority may extend a period within which the person under review may make submissions if:\n\n (a) the person applies, in writing, for the period to be extended; and\n\n (b) the application is made before the end of the period; and\n\n (c) the Authority considers that it is reasonable to extend the period.\n\n37  Subsection 106T(1)\n\nRepeal the subsection, substitute:\n\n (1) The Determining Authority must, after taking into account any submissions made by the person under review in accordance with section 106SA:\n\n (a) make a draft determination in accordance with section 106U relating to the person; and\n\n (b) give copies of the draft determination to the person and to the Director.\n\n (1A) The Determining Authority must comply with subsection (1) within 1 month after the last day on which the person under review may make submissions in accordance with section 106SA.\n\nNote: The period for making the draft determination may be affected by section 106TB.\n\n38  At the end of subsection 106T(2)\n\nAdd:\n\nNote: The period for making submissions may be affected by section 106TB.\n\n39  Subsection 106T(4)\n\nOmit “that paragraph”, substitute “subsection (1A)”.\n\n40  At the end of subsection 106TA(1)\n\nAdd:\n\nNote: The period for making the final determination may be affected by section 106TB.\n\n41  After section 106TA\n\nInsert:\n\n106TB  Time for doing act affected if court order operates\n\n (1) This section applies in relation to an act that is required or permitted by this Subdivision to be done within a particular period (the original action period) if an injunction or other court order prevents the act, or a further act of that kind, from being done within that period.\n\n (2) Despite any other provision of this Subdivision, and subject to any order of a court:\n\n (a) the original action period stops running at the beginning of the period (the suspension period) during which the injunction or other court order prevents the act from being done; and\n\n (b) a new period (the new action period) for doing the act, being a period of the same length as the original action period, starts running on the day after the end of the suspension period.\n\n (3) For the purposes of this Subdivision, if:\n\n (a) the original action period was a period in which the person under review was permitted to make submissions in accordance with section 106SA or 106T; and\n\n (b) the person made a submission within that period;\n\nthen the person is taken to have made the submission during the new action period.\n\n42  Application of items 35, 36, 37 and 39\n\nThe repeals and amendments of the Health Insurance Act 1973 made by items 35, 36, 37 and 39 of this Schedule do not apply, in relation to the making of a draft determination or a final determination in relation to a person under review under Part VAA of that Act, if the Committee’s final report in relation to the person was given to the Determining Authority under subsection 106L(3) of that Act before the day this item commences.\n\n\n\n\nPart 5—No further action to be taken in certain circumstances\n\nHealth Insurance Act 1973\n\n43  Subsection 106G(6)\n\nRepeal the subsection.\n\n44  After section 106G\n\nInsert:\n\n106GA  Notification by Director or Committee that proper investigation is impossible\n\n (1) The Director may give the Committee written notice that he or she is satisfied that circumstances exist that would make a proper investigation by the Committee impossible. The notice must set out the circumstances.\n\n (2) The Committee may give the Director written notice that it is satisfied that circumstances exist that would make a proper investigation by the Committee impossible. The notice must set out the circumstances.\n\n (3) If the Director or the Committee gives a notice under this section:\n\n (a) this Division ceases to have effect in relation to the Committee; and\n\n (b) the Director must, within 7 days after giving or receiving the notice (as the case may be), give a copy of the notice to the Chief Executive Medicare and the person under review.\n\n45  Division 5 of Part VAA (heading)\n\nRepeal the heading, substitute:\n\nDivision 5—Determining Authority\n\nSubdivision A—Establishment etc. of the Determining Authority\n\n46  Before section 106R\n\nInsert:\n\nSubdivision B—Ratification of agreements by the Determining Authority\n\n106QA  Application of Subdivision\n\n  This Subdivision applies if an agreement entered into between the Director and a person under review under section 92 is referred to the Determining Authority for ratification.\n\n106QB  Notification by Director or Authority that action in agreement cannot take effect\n\n (1) The Director may give the Determining Authority written notice that he or she is satisfied that circumstances exist that would make it impossible for an action specified in the agreement to take effect. The notice must set out the circumstances.\n\n (2) The Determining Authority may give the Director written notice that it is satisfied that circumstances exist that would make it impossible for an action specified in the agreement to take effect. The notice must set out the circumstances.\n\n (3) If the Director or the Determining Authority gives a notice under this section:\n\n (a) section 106R ceases to have effect in relation to the agreement; and\n\n (b) the Director must, within 7 days after giving or receiving the notice (as the case may be), give a copy of the notice to the Chief Executive Medicare and the person under review.\n\n47  Section 106R (heading)\n\nRepeal the heading, substitute:\n\n106R  Authority must ratify or refuse to ratify agreement\n\n48  Subsection 106R(1)\n\nRepeal the subsection, substitute:\n\n (1) The Determining Authority must, within 1 month after the day on which it receives the agreement, make a decision either ratifying or refusing to ratify the agreement.\n\n49  After section 106R\n\nInsert:\n\nSubdivision C—Determinations by the Determining Authority\n\n106RA  Application of Subdivision\n\n  This Subdivision applies if a final report of a Committee is given to the Determining Authority under subsection 106L(3) in relation to a person under review.\n\n106RB  Notification by Director or Authority that proper draft or final determination is impossible\n\n (1) The Director may give the Determining Authority written notice that he or she is satisfied that circumstances exist that would make it impossible for a proper draft determination or final determination to be made by the Authority in relation to the person under review. The notice must set out the circumstances.\n\n (2) The Determining Authority may give the Director written notice that it is satisfied that circumstances exist that would make it impossible for a proper draft determination or final determination to be made by the Authority in relation to the person under review. The notice must set out the circumstances.\n\n (3) If the Director or the Determining Authority gives a notice under this section:\n\n (a) this Subdivision ceases to have effect in relation to the person under review; and\n\n (b) the Director must, within 7 days after giving or receiving the notice (as the case may be), give a copy of the notice to the Chief Executive Medicare and the person under review.\n\n\n\n\nPart 6—Date of effect for final determinations\n\nHealth Insurance Act 1973\n\n50  Subsection 106V(2)\n\nRepeal the subsection, substitute:\n\n (2) If, before that 35th day, a proceeding is instituted in a court in respect of the final determination, the determination takes effect (subject to any order of the court) at the end of:\n\n (a) if the application instituting the proceeding is withdrawn or the proceeding is discontinued—7 days after the day on which the application is withdrawn or the proceeding is discontinued; or\n\n (b) if the proceeding is dismissed or determined—the prescribed number of days after the day on which the proceeding is dismissed or determined; or\n\n (c) if an appeal is instituted but the appeal is withdrawn or discontinued—7 days after the day on which the appeal is withdrawn or discontinued; or\n\n (d) if an appeal is instituted and the appeal is dismissed or determined—the prescribed number of days after the day on which the appeal is dismissed or determined.\n\n51  Application\n\nThe amendment of the Health Insurance Act 1973 made by this Part does not apply in relation to a final determination that was made under section 106TA of that Act before the day this item commences.\n\n\n\n\nPart 7—Referrals to Medicare Participation Review Committee\n\nHealth Insurance Act 1973\n\n52  Subparagraph 19B(2)(a)(i)\n\nOmit “, 124FAA(2)(e)”.\n\n53  Subparagraph 19B(2)(b)(i)\n\nOmit “, 124FAA(2)(d)”.\n\n54  Subparagraph 19B(2)(c)(iii)\n\nOmit “, 124FAA(2)(e)”.\n\n55  Subparagraph 19B(2)(d)(iii)\n\nOmit “, 124FAA(2)(d)”.\n\n56  Subsection 19D(11) (paragraph (a) of the definition of disqualified practitioner)\n\nOmit “, 124FAA(2)(d) or (e)”.\n\n57  Paragraphs 92(2)(f) and (g)\n\nOmit “of not more than 3 years”.\n\n58  After subsection 92(2)\n\nInsert:\n\n (2A) For the purposes of paragraphs (2)(f) and (g), the period specified must not be more than:\n\n (a) if the person is a practitioner in relation to whom an agreement under this section, or a final determination under section 106TA, has previously taken effect—5 years; or\n\n (b) in any other case—3 years.\n\n59  Paragraph 92(4)(e)\n\nOmit “jurisdiction; and”, substitute “jurisdiction.”.\n\n60  Paragraph 92(4)(f)\n\nRepeal the paragraph.\n\n61  Paragraph 106U(1)(g)\n\nAfter “disqualified”, insert “, for a specified period starting when the determination takes effect,”.\n\n62  At the end of paragraph 106U(1)(h)\n\nAdd “for a specified period starting when the determination takes effect”.\n\n63  Subsections 106U(3) and (4)\n\nRepeal the subsections, substitute:\n\n (3) For the purposes of paragraphs (1)(g) and (h), the period specified must not be more than:\n\n (a) if the person under review is a practitioner in relation to whom an agreement under section 92, or a final determination under section 106TA, has previously taken effect—5 years; or\n\n (b) in any other case—3 years.\n\n64  Section 106X\n\nRepeal the section.\n\n65  Subsection 106ZPR(2)\n\nRepeal the subsection.\n\n66  Subsection 124E(2A)\n\nRepeal the subsection.\n\n67  Subsection 124E(5)\n\nOmit “106X or”.\n\n68  Subsection 124E(5)\n\nOmit “, (2A)”.\n\n69  Subsection 124EA(1)\n\nOmit “, (2A)”.\n\n70  Section 124FAA\n\nRepeal the section.\n\n71  Subsection 124H(7)\n\nOmit “124FAA(2),”.\n\n72  Subsection 124J(8)\n\nOmit “, (2A)”.\n\n73  Subsection 124S(9)\n\nOmit “or paragraph 124FAA(2)(d) or (e)”.\n\n74  Application\n\nThe repeals and amendments of the Health Insurance Act 1973 made by this Part do not apply in relation to a request to review the provision of services by a person that was made under section 86 of that Act before the day this item commences.\n\n\n\n\nPart 8—Referrals to appropriate regulatory bodies\n\nHealth Insurance Act 1973\n\n75  Paragraph 93(8)(a)\n\nOmit “an appropriate body”, substitute “a person or body”.\n\n76  Subsection 93(8)\n\nOmit “the appropriate body”, substitute “the person or body”.\n\n77  Section 106XA (heading)\n\nRepeal the heading, substitute:\n\n106XA  Significant threat to life or health\n\n78  Before subsection 106XA(1)\n\nInsert:\n\nOpinion formed by Committee or Determining Authority\n\n79  Subsections 106XA(2) to (4)\n\nRepeal the subsections, substitute:\n\n (2) If the Director receives, from a Committee or the Determining Authority, a statement and material under subsection (1) in relation to conduct by a person under review, the Director must send the statement and material to:\n\n (a) a State or Territory body that is responsible for the administration of health services or the protection of public health and safety in the State or Territory in which the conduct occurred; and\n\n (b) each appropriate person or body for the person under review (see subsection (4)).\n\nOpinion formed by Director\n\n (3) If, in the course of or in connection with the performance of functions or the exercise of powers (whether by the Director, the Director’s nominee, a Committee or the Determining Authority) under this Part in relation to a person under review, the Director forms the opinion that any conduct by the person has caused, is causing, or is likely to cause, a significant threat to the life or health of any other person, the Director must:\n\n (a) prepare a written statement of his or her concerns; and\n\n (b) attach to the statement the material, or copies of the material, on which his or her opinion is based; and\n\n (c) send the statement and material to:\n\n (i) a State or Territory body that is responsible for the administration of health services or the protection of public health and safety in the State or Territory in which the conduct occurred; and\n\n (ii) each appropriate person or body for the person under review (see subsection (4)).\n\nMeaning of appropriate person or body\n\n (4) For the purposes of paragraph (2)(b) and subparagraph (3)(c)(ii), an appropriate person or body for a person under review is a person or body that:\n\n (a) is specified in the regulations; and\n\n (b) has the power to take action against the person under review.\n\n80  Section 106XB (heading)\n\nRepeal the heading, substitute:\n\n106XB  Non‑compliance by a practitioner with professional standards\n\n81  Paragraph 106XB(2)(a)\n\nRepeal the paragraph, substitute:\n\n (a) in the course of or in connection with the performance of functions or the exercise of powers (whether by the Director, the Director’s nominee, a Committee or the Determining Authority) under this Part in relation to a person under review who is a practitioner, the Director forms the opinion that the practitioner has failed to comply with professional standards; or\n\n\n\n\nPart 9—Disqualified practitioners\n\nHealth Insurance Act 1973\n\n82  Subparagraphs 19B(2)(a)(ii) and (c)(iv)\n\nOmit “partly”, substitute “fully”.\n\n83  Subsection 19D(1)\n\nAfter “section 19B”, insert “or 106ZPM”.\n\n84  Subsection 19D(11) (paragraph (c) of the definition of disqualified practitioner)\n\nOmit “fully”.\n\n85  Subsection 19D(11) (paragraph (e) of the definition of disqualified practitioner)\n\nOmit “paragraph 106U(1)(h) that the practitioner be fully disqualified”, substitute “paragraph 106U(1)(g) or (h)”.\n\n86  Subsection 19D(11) (note at the end of the definition of disqualified practitioner)\n\nRepeal the note.\n\n\n\n\nPart 10—Patient referrals\n\nHealth Insurance Act 1973\n\n87  After section 132\n\nInsert:\n\n132A  Regulations relating to the manner of patient referrals\n\n (1) If an item specifies a service that is to be rendered by a practitioner to a patient who has been referred to the practitioner, the regulations may require that, for the purposes of the item, the patient is to be referred in a manner prescribed by the regulations.\n\n (2) In this section:\n\nitem includes an item relating to a service specified in a determination in force under subsection 3C(1).\n\npractitioner has the same meaning as in section 124B.\n\n88  Subsection 133(2)\n\nRepeal the subsection.\n\n\n\n\nSchedule 3—Technical amendments relating to legislative instruments\n\n \n\nHealth Insurance Act 1973\n\n1  Subsection 86(5)\n\nAfter “Minister may”, insert “, by legislative instrument,”.\n\n2  Subsection 86(6)\n\nRepeal the subsection.\n\n3  Subsection 93(4)\n\nOmit “in writing”, substitute “by legislative instrument”.\n\n4  Subsection 93(5)\n\nRepeal the subsection.\n\n5  Subsection 106K(3)\n\nOmit “make written”, substitute “, by legislative instrument, make”.\n\n6  Subsection 106K(5)\n\nRepeal the subsection.\n\n7  Subsection 106Q(3)\n\nAfter “Minister may”, insert “, by legislative instrument,”.\n\n8  Subsection 106Q(4)\n\nRepeal the subsection.\n\n9  At the end of section 124FAA\n\nAdd:\n\n (7) In this section, a reference to a final determination under section 106TA includes a reference to an agreement that, under paragraph 92(4)(f), is taken to be a final determination for the purposes of section 106X.\n\n \n\n \n\n[Minister’s second reading speech made in—\n\nHouse of Representatives on 9 May 2012\n\nSenate on 10 May 2012]\n\n(35/12)\n\n \n","sortOrder":0}],"analysis":{"kimi_summary":{"content_quality":"ok","complexity_score":7,"scope_assessment":{"changed":true,"description":"The legislation has grown significantly beyond its original validation purpose. While Schedule 1 addresses the immediate constitutional/validity crisis regarding panel appointments, Schedule 2 represents a major expansion of the Professional Services Review Scheme's scope: (1) introducing an entirely new enforcement trigger ('prescribed pattern of services') that moves beyond individual case review to pattern-based detection; (2) extending coverage from medical practitioners to allied health practitioners (chiropractors, physiotherapists, podiatrists, osteopaths, and Minister-determined professions); and (3) restructuring internal processes with new time limits, suspension mechanisms, and termination powers. Parts 7-10 further expand scope by increasing maximum disqualification periods from 3 to 5 years for repeat offenders and creating new regulatory referral pathways. The original 'validation' purpose in the short title is now a minor component of a broader scheme strengthening and expansion."},"complexity_factors":["Extensive cross-referencing to the Health Insurance Act 1973 (amending multiple Parts: VAA, VB, VII)","Retroactive validation provisions with specific exceptions (Schedule 1, items 1-4)","Nested conditional logic: new 'prescribed pattern of services' definition with exceptions for 'exceptional circumstances' (section 82(1A)-(1D))","Multiple commencement dates across three Schedules (Royal Assent, 6-month proclamation window, day after Royal Assent)","Transitional and application provisions preserving old law for pending matters (items 15, 28-30, 42, 51, 74)","47+ discrete amendment items across 10 Parts plus Schedule 3","Interaction between new Ministerial determination powers for allied health practitioners and existing definitions","Complex timing rules for determinations with suspension periods during court orders (new section 106TB)","Repeal and replacement of multiple sections with new subdivision structures (Division 5 of Part VAA restructured)","Constitutional safety net provision for property acquisition (Schedule 1, item 3) requiring interpretation of s 51(xxxi)"],"plain_english_summary":"**What this law does:**\n\nThis Act makes three main types of changes to how Medicare monitors and penalises doctors and other health professionals who claim benefits inappropriately.\n\n**1. It validates past decisions (Schedule 1)**\n- **The problem:** Some past decisions by review panels might have been legally invalid because panel members weren't properly appointed.\n- **The fix:** This law retroactively validates those decisions, so they stand as if they were always proper. It protects people who relied on those decisions.\n- **Exception:** If someone already has High Court appeal leave granted, and the appointment issue is part of their case, this validation doesn't apply to them.\n- **Safety net:** If someone wins a case because of the appointment problem, the Director can re-refer their case to a new committee within 12 months.\n\n**2. It expands and improves the Professional Services Review Scheme (Schedule 2)**\n- **New trigger for review:** The Chief Executive Medicare must now request a review if a practitioner shows a \"prescribed pattern of services\" (specific thresholds set by regulations, like seeing too many patients on too many days).\n- **Exceptional circumstances:** Practitioners can argue they shouldn't be penalised if exceptional circumstances applied on specific days (e.g., a local emergency).\n- **Allied health practitioners:** The scheme now covers more than just doctors—chiropractors, physiotherapists, podiatrists, osteopaths, and other health professionals the Minister determines can now be reviewed.\n- **Clearer definitions:** Clarifies that \"services\" includes both rendered services and initiated services (where Medicare benefit would have been payable).\n- **Better timeframes:** Extends deadlines for committees when there are delays like illness, disqualification, or court orders. Stops the clock during court injunctions.\n- **Streamlined process:** Removes redundant steps and allows the Director or Determining Authority to stop proceedings if a proper investigation becomes impossible.\n\n**3. It strengthens penalties and referrals (Parts 7-10)**\n- **Longer bans:** Repeat offenders can now be disqualified for up to 5 years instead of just 3.\n- **Simpler referrals:** Removes complex duplicate referral pathways to the Medicare Participation Review Committee.\n- **Better reporting:** Committees must report serious threats to life or health to relevant state/territory health bodies and professional regulators.\n- **Referral rules:** Allows regulations to specify how patients must be referred to specialists for Medicare purposes.\n\n**4. Technical updates (Schedule 3)**\n- Converts various Ministerial determinations and guidelines into \"legislative instruments\" (a more formal, parliamentary-scrutinised form of delegated legislation).\n\n**Who it affects:**\n- **Doctors and health professionals** who bill Medicare—now including allied health practitioners.\n- **Medicare review bodies** (Professional Services Review Scheme, Determining Authority).\n- **Patients** (indirectly, through better monitoring of practitioner conduct and clearer referral rules).\n\n**Why it matters:**\nThis law tightens Medicare integrity by making it easier to catch and penalise inappropriate billing patterns, closes legal loopholes that could invalidate past enforcement actions, expands oversight to more types of health professionals, and creates clearer, fairer processes with better time limits and appeal rights."},"flash_summary":{"complexity_score":8,"scope_assessment":{"changed":true,"description":"The Act extends and reshapes the operational scope of the Professional Services Review scheme: it creates a new statutory trigger concept (\"prescribed pattern of services\") to prompt mandatory review requests by the Chief Executive Medicare (new section 82A and subsection 86(1A)), expands the class of persons who may be ‘‘practitioners’’ under Parts VAA and VB via Ministerial legislative instrument (new subsections 81(1A) and 124B(7)), and widens what counts as a reviewable \"service\" to include services \"initiated\" at times when Medicare benefit would have been payable (new paragraphs 81(1)(a) and (ab)). The Act also changes procedural and temporal mechanics (extensions, submissions, injunction pauses, notice‑based cessation of investigations), introduces statutory routes for re‑referral where appointments were invalidated, and mandates information sharing with State/Territory health bodies and specified regulatory bodies where life/health threats are identified (Schedule 1 and Schedule 2 provisions). These are substantive changes to coverage, definitions and process compared to the pre‑amendment statutory framework set out in the Health Insurance Act 1973."},"complexity_factors":["Multiple cross‑references across Parts VAA, VB and VII of the Health Insurance Act and within the Schedule changes (many amended sections interlock).","Retroactive validation with limited exceptions and an express compensation clause (Schedule 1), raising constitutional and procedural interactions.","Delegation of substantive definitions (\"prescribed pattern of services\", \"appropriate person or body\") to regulations, increasing dependence on delegated instruments for operative scope (new section 82A, section 132A, Schedule 3).","Ministerial power to expand scheme coverage by legislative instrument (new subsections 81(1A), 124B(7)), shifting scope through executive instruments rather than Parliament.","Detailed procedural timing rules with stop‑the‑clock and extension mechanics tied to illness, suspension, injunctions and court proceedings (sections 106G, 106TB, 106SA, 106T, 106V), creating intricate time management interactions.","Introduction of new notice powers that terminate parts of the process where proper investigation or action is impossible (sections 106GA, 106QB, 106RB), adding conditional termination pathways.","Changes to information‑sharing obligations to State/Territory bodies and regulatory bodies where serious risk is identified (sections 106XA–106XB), introducing multi‑jurisdictional coordination.","Differential caps on periods of disqualification depending on prior history (new subsection 92(2A) and related amendments), requiring historical analysis in disposition decisions."],"plain_english_summary":"What this Act changes, in plain terms\n\n- Retroactive validation of past Panel/Deputy Director actions (Schedule 1, item 1).  The Act says that acts done under Parts VAA, VB or VII of the Health Insurance Act 1973 are taken to have been valid even if a person who purported to act as a Panel member or Deputy Director was not validly appointed.  That validation does not apply where the invalid appointment is currently (as at commencement) in issue before the High Court (Schedule 1, subitems (1)–(4)).\n\n- Re-referral after procedural quashing (Schedule 1, item 2).  If proceedings were decided for a practitioner because of an invalid appointment, the Director may, within 12 months of that final decision, set up a fresh Committee and re‑refer the same services for review; the new Committee may consider evidence from the prior investigation and the court proceedings (Schedule 1, item 2(2)–(4)).\n\n- Compensation if the validation operates as an acquisition of property (Schedule 1, item 3).  If the Schedule’s operation amounts to an acquisition otherwise than on just terms, the Commonwealth must pay reasonable compensation (Schedule 1, item 3).\n\n- New statutory concept: “prescribed pattern of services” and how it is used (Schedule 2, Part 1).  The Act inserts a statutory concept called \"prescribed pattern of services\" (new section 82A).  The regulations may define particular kinds of circumstances (for example, repeated provision or initiation of specified services across multiple days) that will constitute a prescribed pattern (Schedule 2, items 1–6 and new section 82A).  If services fall into that prescribed pattern, a practitioner can be treated as engaging in \"inappropriate practice\" for the relevant period (new subsection 82(1A)).  The Committee must consider whether exceptional circumstances applied on particular days (subsections 82(1B)–(1D)) and regulations may specify exceptional circumstances (Schedule 2, items 3 and 6).\n\n- Mandatory review requests by Chief Executive Medicare when a prescribed pattern is detected (Schedule 2, items 7–12).  If the Chief Executive Medicare becomes aware that a practitioner’s services constitute a prescribed pattern, the Chief Executive must request a Director review under section 86 (new subsection 86(1A)); such a request may include other reasons in addition to the prescribed pattern (Schedule 2, items 8–11, 12).\n\n- Extension of the PSR scheme to certain allied health practitioners by ministerial determination (Schedule 2, Part 2).  The Minister may, by legislative instrument, declare that a specified kind of health professional is a \"practitioner\" for the purposes of Part VAA or Part VB, and can declare a vocation as a \"profession\" for these Parts (new subsections 81(1A) and 124B(7); Schedule 2, items 16–18, 25–26).  The Authority’s membership rules and Committee composition are amended so that members must be the same kind of practitioner as the person under review in certain cases (Schedule 2, items 20–27).  Transitional rules prevent review of services that were provided before a ministerial determination took effect in certain circumstances (Schedule 2, items 28–30).\n\n- Broader definition of a \"service\" to include services that were \"initiated\" where Medicare benefit would have been payable at the time of initiation (Schedule 2, Part 3: new definition in subsection 81(1), items 31–32).  That changes which activity can be the subject of review: not only services actually rendered but services initiated at a time when Medicare benefit would have been payable.\n\n- Timeframes and process changes for committee reports, draft and final determinations, and court interaction (Schedule 2, Part 4).  The Committee may extend the 6‑month period to produce a final report for specified reasons (illness, suspension, failure to comply with certain notices, injunctions) and may grant multiple extensions (new subsection 106G(3) and (4A), Schedule 2, items 33–34).  The Director may provide information to the Determining Authority only once and not after the draft determination is made (amendments to section 106S and related provisions, Schedule 2, items 35–38).  The Determining Authority must invite written submissions from the person under review and follow specific timing rules for making a draft determination and giving copies to parties (new sections 106SA, amended 106T and related items 36–40).  If a court injunction prevents an act from being done, the statutory time period is suspended and recommences once the injunction ends (new section 106TB, item 41).\n\n- When investigation, draft action, or agreement ratification cannot properly proceed (Schedule 2, Parts 5 and 6).  The Director or the Committee can give written notice that circumstances make a proper investigation impossible; if that notice is given, the Division ceases to apply in relation to that Committee and the Director must notify the Chief Executive Medicare and person under review (new section 106GA, item 44).  Similar notice powers are added for the Determining Authority when agreements are referred for ratification or when it is impossible to make a proper draft or final determination (new Subdivisions B and C: sections 106QA–106QB and 106RA–106RB, Schedule 2, items 45–46 and 49).\n\n- Timing of when a final determination takes effect if court proceedings are started (Schedule 2, Part 6).  If court proceedings are instituted before the 35th day after a final determination, the determination’s operative date is moved to the end of defined periods depending on whether proceedings or appeals are withdrawn, discontinued, dismissed, or determined (amended subsection 106V(2), item 50).\n\n- Changes to referral pathways and lengths of disqualification (Schedule 2, Parts 7 and 9).  The Act adjusts which conduct may be referred to the Medicare Participation Review Committee and removes earlier cross‑references to repealed provisions (items 52–56).  It removes a fixed 3‑year cap on some outcomes and replaces it with a regime where the period may be up to 5 years for repeat cases and up to 3 years otherwise (new subsection 92(2A) and related changes, items 57–64).  Several other sections concerning disqualification and references to a now‑repealed section are removed or amended (items 64–74, 82–86).\n\n- Material sent to regulatory or state bodies where serious risk is identified (Schedule 2, Part 8).  If a Committee, the Determining Authority or the Director forms an opinion that conduct has caused or is likely to cause a significant threat to life or health, the Director must prepare a written statement and send the statement and supporting material to the relevant State/Territory health body where the conduct occurred and to each \"appropriate person or body\" defined by the regulations (new/updated sections 106XA–106XB, Schedule 2, items 75–81).  The Director must also send statements and material received from a Committee or Determining Authority to those recipients (Schedule 2, item 79).\n\n- Regulations may prescribe the manner of patient referrals for items (Schedule 2, Part 10).  Regulations may require that, for a listed Medicare item, the patient be referred in a manner prescribed by regulation for the service to qualify (new section 132A, item 87).\n\n- Technical change: several powers and forms are converted to be exercisable \"by legislative instrument\" rather than other forms of writing (Schedule 3, items 1–9).\n\nWho pays, who decides and what changes in behaviour the law creates (mechanical, source‑grounded)\n\n- Who pays: the Commonwealth bears the cost of compensation if the Schedule’s validation effects amount to an acquisition of property otherwise than on just terms (Schedule 1, item 3). Administrative and compliance costs (for example extra submissions, extended processes, or legal challenges) are borne by practitioners, the Director, Committees and the Determining Authority as they implement the new procedures (see Schedule 2, items 33–41, 45–49).\n\n- Who decides: the Minister (by legislative instrument) can add kinds of health professionals into the PSR scheme (new subsections 81(1A) and 124B(7), Schedule 2, items 18 and 26).  The Chief Executive Medicare must request a review when a prescribed pattern of services is identified (new subsection 86(1A), Schedule 2, item 10).  Committees, the Director and the Determining Authority retain decision‑making roles for investigations, reports, draft/final determinations and ratification of agreements, but the Act adds specified notice powers (sections 106GA, 106QB, 106RB) that allow those bodies to notify and cease proceedings when proper investigation or action is impossible (Schedule 2, items 44–49).  Regulations (made under the Health Insurance Act) are used to define detailed matters: what circumstances count as a prescribed pattern, what counts as an appropriate person or body for referral, and how referrals must be made for certain items (new section 82A and 132A, Schedule 2, items 6, 79, 87; Schedule 3 technical items).\n\n- What behaviour the law changes (mechanically):\n  - It empowers the Chief Executive Medicare to trigger reviews when a regulated pattern of service provision is detected, increasing monitoring and potential review actions (new subsection 86(1A), Schedule 2, item 10).\n  - It expands the reach of the PSR scheme to additional health professional kinds if the Minister so determines (new subsections 81(1A) and 124B(7), Schedule 2, items 18 and 26), but limits retrospective application for periods before a ministerial determination took effect (Schedule 2, items 28–30).\n  - It changes what counts as a reviewable activity by including services that were \"initiated\" where Medicare benefit would have been payable at the time of initiation (Schedule 2, items 31–32).\n  - It tightens and clarifies procedural timelines for report production, submissions and determinations, while providing mechanisms to pause or extend those timelines where courts intervene or other specified events occur (Schedule 2, items 33–41).\n  - It requires information to be passed to state health authorities and specified regulatory bodies where a significant threat to life or health is identified (Schedule 2, items 75–81).\n\nImplementation and compliance features, incentives, trade‑offs and practical risks (source‑grounded)\n\n- Delegated rule‑making and discretionary determinations: the Minister may widen the cohort of regulated practitioners by legislative instrument (new subsections 81(1A) and 124B(7), Schedule 2, items 18 and 26).  That shifts substantive scope decisions from Parliament to executive instruments; compliance and operational scope depend on what the Minister determines by instrument and what the regulations prescribe (section 82A and related items).\n\n- Regulatory detail by regulation: the substantive concept \"prescribed pattern of services\" is not specified on the face of the Act but left to regulations (new section 82A, Schedule 2, item 6).  That means the practical triggers for review depend on delegated instruments rather than the primary Act.\n\n- Process workload and timing trade‑offs: Committees may extend report periods and the Determining Authority must allow and consider submissions; the scheme also contains stop‑the‑clock rules for injunctions (new subsection 106G(3), 106TB and sections 106SA–106T).  These changes create predictable avenues to lengthen proceedings (for illness, suspension, court orders, failure to comply with notices), which affects how quickly matters reach final determinations and may increase administrative workload for the Director and Determining Authority (Schedule 2, items 33–41).\n\n- Judicial interaction and re‑referral: the Act retroactively validates actions but preserves ongoing High Court matters (Schedule 1, items 1(4)).  Where prior proceedings succeeded because of invalid appointments, the Director may re‑refer within 12 months (Schedule 1, item 2).  This creates a mechanism to re‑start review processes after courts have quashed earlier processes due to appointment defects.\n\n- Information sharing and referral to external regulators: where the Director, Committee or Determining Authority forms particular opinions about risks to life or health or non‑compliance with professional standards, they must send statements and material to state health authorities and to \"appropriate\" regulatory bodies identified in regulations (Schedule 2, items 75–81).  That changes the flow of material from a primarily Commonwealth administrative review scheme into state/other regulatory systems.\n\n- Compensation exposure: the Commonwealth accepts potential liability for compensation where the validation operates as an acquisition otherwise than on just terms (Schedule 1, item 3).  That creates a potential fiscal exposure tied to the retroactive validation measure.\n\nWhere the text points to concentrated benefits or diffuse costs\n\n- Concentrated benefits: a validated past action protects specific administrative decisions, Committees’ outputs and determinations (Schedule 1, item 1).  Expanding the scheme to additional practitioner kinds concentrates regulatory reach on particular professional groups when the Minister makes a determination (Schedule 2, items 18, 26).\n\n- Diffuse costs: broader procedural rules, additional submissions and extended timelines may impose administrative cost and time‑burden across the PSR apparatus and on practitioners who may be newly captured by ministerial determination or by regulations defining prescribed patterns (multiple items in Schedule 2).  The Act leaves many definitional and procedural details to regulation or ministerial instrument, so the precise distribution of costs depends on those instruments (new section 82A and legislative instrument powers in Schedule 3).\n\nKey statutory citations (representative)\n\n- Retroactive validation: Schedule 1, item 1 (subitems (1)–(5)).\n- Re‑referral after quashing due to appointment defects: Schedule 1, item 2 (subitems (1)–(4)).\n- Compensation for acquisition: Schedule 1, item 3.\n- Prescribed pattern of services and exceptional circumstances: Schedule 2, new subsections 82(1A)–(1D) and section 82A (Schedule 2, items 3 and 6).\n- Chief Executive Medicare must request review for prescribed pattern: new subsection 86(1A) (Schedule 2, item 10).\n- Ministerial determination of additional practitioner kinds: new subsections 81(1A) and 124B(7) (Schedule 2, items 18 and 26).\n- Definition of service to include initiated services: new paragraphs 81(1)(a) and (ab) (Schedule 2, items 31–32).\n- Time extensions, submissions and injunction stop‑the‑clock: amended section 106G (Schedule 2, item 33), new section 106TB (item 41), and new section 106SA (item 36).\n- Notices that proper investigation or action is impossible: new sections 106GA, 106QB and 106RB (Schedule 2, items 44–46 and 49).\n- Information to State/Territory bodies and regulators where significant threat identified: amended/new sections 106XA–106XB (Schedule 2, items 77–81).\n- Regulations may prescribe referral manner for patient items: new section 132A (Schedule 2, item 87).\n\nPractical note: Many substantive triggers, definitions and destination bodies are left to regulations or to ministerial legislative instruments (see new section 82A; new subsections 81(1A) and 124B(7); Schedule 3 technical amendments). That means the Act sets the framework and decision points, while detailed implementation will depend on instruments made under the Health Insurance Act."}},"importantCases":[],"_links":{"self":"/api/acts/health-insurance-amendment-professional-services-review-act-2012","history":"/api/acts/health-insurance-amendment-professional-services-review-act-2012/history","analysis":"/api/acts/health-insurance-amendment-professional-services-review-act-2012/analysis","conflicts":"/api/acts/health-insurance-amendment-professional-services-review-act-2012/conflicts","importantCases":"/api/acts/health-insurance-amendment-professional-services-review-act-2012/important-cases","documents":"/api/acts/health-insurance-amendment-professional-services-review-act-2012/documents"}}