{"id":"nsw:sl-2021-0253","name":"State Insurance and Care Governance Regulation 2021","slug":"state-insurance-and-care-governance-regulation-2021","collection":"regulation","jurisdiction":"nsw","status":"in_force","isInForce":true,"actNumber":"253 of 2021","makingDate":null,"administeringDepartment":null,"currentVersion":{"id":176270,"registerId":"nsw-nsw:sl-2021-0253-current","compilationNumber":null,"startDate":"2026-04-05","status":"InForce","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"1","sectionType":"section","heading":"Name of Regulation","content":"#### 1 Name of Regulation\n\n1 Name of Regulation\n\n> This Regulation is the [State Insurance and Care Governance Regulation 2021](/view/html/inforce/current/sl-2021-0253).","sortOrder":0},{"sectionNumber":"2","sectionType":"section","heading":"Commencement","content":"#### 2 Commencement\n\n2 Commencement\n\n> This Regulation commences on the day on which it is published on the NSW legislation website.\n> \n> Note—\n> \n> This Regulation repeals and replaces the [State Insurance and Care Governance Regulation 2015](/view/html/repealed/current/sl-2015-0530), which would otherwise be repealed on 1 September 2021 by section 10(2) of the [Subordinate Legislation Act 1989](/view/html/inforce/current/act-1989-146).","sortOrder":1},{"sectionNumber":"3","sectionType":"section","heading":"Definitions","content":"#### 3 Definitions\n\n3 Definitions\n\n> In this Regulation—\n> \n> the Act means the [State Insurance and Care Governance Act 2015](/view/html/inforce/current/act-2015-019).\n> \n> Note—\n> \n> The Act and the [Interpretation Act 1987](/view/html/inforce/current/act-1987-015) contain definitions and other provisions that affect the interpretation and application of this Regulation.","sortOrder":2},{"sectionNumber":"4","sectionType":"section","heading":"Authorised persons","content":"#### 4 Authorised persons\n\n4 Authorised persons\n\n> For the purposes of section 26 of the Act, the following are prescribed as authorised persons—\n> \n> > (a) a Public Service employee within the meaning of the [Government Sector Employment Act 2013](/view/html/inforce/current/act-2013-040),\n> \n> > (b) a statutory officer.","sortOrder":3},{"sectionNumber":"4A","sectionType":"section","heading":"Relevant services—the Act, s 26A","content":"#### 4A Relevant services—the Act, s 26A\n\n4A Relevant services—the Act, s 26A\n\n> > (1) For the Act, section 26A, definition of relevant service, the following services are prescribed—\n> > \n> > > (a) audiology and audiometry services,\n> > \n> > > (b) Chinese medicine services,\n> > \n> > > (c) chiropractic services,\n> > \n> > > (d) counselling services,\n> > \n> > > (e) dental services,\n> > \n> > > (f) dietetics and nutrition services,\n> > \n> > > (g) exercise physiology services,\n> > \n> > > (h) massage therapy services,\n> > \n> > > (i) medical radiation practice services,\n> > \n> > > (j) medical services,\n> > \n> > > (k) nursing services,\n> > \n> > > (l) occupational therapy services,\n> > \n> > > (m) optometry services,\n> > \n> > > (n) osteopathy services,\n> > \n> > > (o) patient transport services,\n> > \n> > > (p) pharmaceutical services,\n> > \n> > > (q) physiotherapy services,\n> > \n> > > (r) podiatry services,\n> > \n> > > (s) psychology services,\n> > \n> > > (t) rehabilitation services,\n> > \n> > > (u) social work services,\n> > \n> > > (v) speech therapy services,\n> > \n> > > (w) services provided to injured persons relating to the provision and maintenance of aids, appliances or prostheses, including the following—\n> > > \n> > > > (i) artificial body parts or other artificial aids,\n> > > \n> > > > (ii) aids for activities of daily living,\n> > > \n> > > > (iii) mobility aids,\n> > > \n> > > > (iv) equipment provided as part of treatment or therapy services,\n> > \n> > > (x) domestic assistance services provided to injured persons, including household cleaning and laundry, lawn or garden care and transport services,\n> > \n> > > (y) private hospital and day surgery services, including in-patient and out-patient services,\n> > \n> > > (z) workplace rehabilitation services,\n> > \n> > > (za) services provided by a health practitioner, not involving treatment, consisting of—\n> > > \n> > > > (i) a medical opinion on the treatment or cause of an injury, or\n> > > \n> > > > (ii) an assessment of a permanent impairment, or\n> > > \n> > > > (iii) a peer review, or\n> > > \n> > > > (iv) facilitating discussions between an injured person and doctors, insurers, employers and other service providers to manage the rehabilitation of the injured person,\n> > \n> > > (zb) administrative services relating to the following—\n> > > \n> > > > (i) referrals, including receiving referrals from or making referrals to, or on behalf of, a health practitioner,\n> > > \n> > > > (ii) administrative functions associated with producing medical evidence relating to a person’s injury, functioning or impairment,\n> > > \n> > > > (iii) access to medical documents, including medical certificates or radiology or medical imaging,\n> > > \n> > > > (iv) centralisation or coordination of referrals or appointments and other administrative functions,\n> > \n> > > (zc) medication management and review, including the assessment and analysis of medication use, cost and prescriber behaviour.\n> \n> > (2) Subsection (1)(zb) does not include administrative services relating to the provision of legal advice to, or representation of, an injured person regarding a claim or dispute under the workers compensation and motor accidents legislation.\n> \n> **s 4A:** Ins 2022 (818), Sch 1\\[1\\].","sortOrder":4},{"sectionNumber":"4B","sectionType":"section","heading":"Relevant service providers—the Act, s 26A","content":"#### 4B Relevant service providers—the Act, s 26A\n\n4B Relevant service providers—the Act, s 26A\n\n> > (1) For the Act, section 26A, definition of relevant service provider, each of the following is not a relevant service provider—\n> > \n> > > (a) a public hospital,\n> > \n> > > (b) a local health district,\n> > \n> > > (c) a specialty network governed health corporation,\n> > \n> > > (d) the Ambulance Service of NSW,\n> > \n> > > (e) the Health Administration Corporation established under the [Health Administration Act 1982](/view/html/inforce/current/act-1982-135),\n> > \n> > > (f) the division of the Ministry of Health known as Health Protection NSW.\n> \n> > (2) Words and expressions used in this section have the same meaning as in the [Health Services Act 1997](/view/html/inforce/current/act-1997-154).\n> \n> **s 4B:** Ins 2022 (818), Sch 1\\[1\\].","sortOrder":5},{"sectionNumber":"4C","sectionType":"section","heading":"Directions—the Act, s 26D(4)","content":"#### 4C Directions—the Act, s 26D(4)\n\n4C Directions—the Act, s 26D(4)\n\n> > (1) A direction must be given to the relevant service provider—\n> > \n> > > (a) personally, or\n> > \n> > > (b) by electronic transmission to an address or location specified by the relevant service provider for receiving directions under the section.\n> \n> > (2) A direction must—\n> > \n> > > (a) include the reasons for the direction, and\n> > \n> > > (b) state that the relevant service provider is entitled to—\n> > > \n> > > > (i) for a direction given under the Act, section 26D(1)(a) or (b)—an internal review of the direction, or\n> > > \n> > > > (ii) for a direction give under the Act, section 26D(1)(c) or (d)—an administrative review of the direction under the Act, section 26F.\n> \n> > (3) A direction may be given to a relevant service provider in the following circumstances—\n> > \n> > > (a) the relevant service provider has not complied with a provision of the workers compensation and motor accidents legislation,\n> > \n> > > (b) the relevant service provider has not complied with guidelines issued under—\n> > > \n> > > > (i) the Act, section 26E, or\n> > > \n> > > > (ii) the workers compensation and motor accidents legislation,\n> > \n> > > (c) the relevant service provider has been referred to, or is under investigation by, a relevant clinical, professional or accreditation body.\n> \n> > (4) A direction—\n> > \n> > > (a) takes effect on the day on which the direction is given or a later day specified in the direction, and\n> > \n> > > (b) remains in force until the day, if any, specified in the direction unless sooner revoked by SIRA.\n> \n> > (5) SIRA may vary a direction given to a relevant service provider by written notice given to the relevant service provider.\n> \n> > (6) In this section—\n> > \n> > direction means a direction under the Act, section 26D.\n> \n> **s 4C:** Ins 2022 (818), Sch 1\\[1\\].","sortOrder":6},{"sectionNumber":"4D","sectionType":"section","heading":"Internal review of directions—the Act, s 26D(4)(f)","content":"#### 4D Internal review of directions—the Act, s 26D(4)(f)\n\n4D Internal review of directions—the Act, s 26D(4)(f)\n\n> > (1) For the Act, section 26D(4)(f), a relevant service provider may apply to SIRA for an internal review of a direction given under the Act, section 26D(1)(a) or (b) within—\n> > \n> > > (a) 28 days after the direction is given, or\n> > \n> > > (b) a longer period specified by SIRA.\n> \n> > (2) An application for an internal review of a direction must be—\n> > \n> > > (a) written, and\n> > \n> > > (b) made in the form and way determined by SIRA.\n> \n> > (3) SIRA is not required to conduct an internal review if an internal review of the direction has already been conducted under this section.\n> \n> > (4) In carrying out an internal review, SIRA may, by written notice to the applicant, request additional information from the applicant.\n> \n> > (5) The applicant must provide the additional information to SIRA within the period specified in the notice.\n> \n> > (6) In determining an application for an internal review, SIRA may—\n> > \n> > > (a) confirm the direction, or\n> > \n> > > (b) vary the direction, or\n> > \n> > > (c) revoke the direction.\n> \n> > (7) SIRA must give written notice to the applicant of the determination of the application for an internal review—\n> > \n> > > (a) within 28 days after the application is received, or\n> > \n> > > (b) if written notice has been given to the applicant requesting additional information from the applicant—within 28 days after SIRA receives the additional information, or\n> > \n> > > (c) if, within 28 days after the application is received, SIRA gives written notice to the applicant that additional time is required to consider the application—within the period specified in the notice.\n> \n> > (8) A determination by SIRA takes effect when written notice of the determination is given to the applicant.\n> \n> > (9) To avoid doubt, a direction that is the subject of an internal review remains in force until SIRA determines the internal review.\n> \n> **s 4D:** Ins 2022 (818), Sch 1\\[1\\].","sortOrder":7},{"sectionNumber":"4E","sectionType":"section","heading":"Register of directed service providers—the Act, s 26G(2)","content":"#### 4E Register of directed service providers—the Act, s 26G(2)\n\n4E Register of directed service providers—the Act, s 26G(2)\n\n> > (1) The register of relevant service providers given directions under the Act, section 26D must be—\n> > \n> > > (a) in the form determined by SIRA, and\n> > \n> > > (b) made freely available to the public on SIRA’s website.\n> \n> > (2) The register must include the following information in relation to each relevant service provider given a direction under the Act, section 26D, unless SIRA considers it appropriate not to include the information—\n> > \n> > > (a) the relevant service provider’s name,\n> > \n> > > (b) the relevant service provider’s ABN or Australian Health Practitioner Regulation Agency registration number,\n> > \n> > > (c) if applicable, the SIRA provider number for the relevant service provider,\n> > \n> > > (d) the relevant services provided by the relevant service provider,\n> > \n> > > (e) information relating to the direction given to the relevant service provider, including—\n> > > \n> > > > (i) the direction given, and\n> > > \n> > > > (ii) the date the direction came into effect.\n> \n> > (3) SIRA may amend or remove information recorded in the register—\n> > \n> > > (a) if SIRA considers the information to be erroneous or misleading, or\n> > \n> > > (b) for another reason SIRA considers appropriate.\n> \n> > (4) If a direction is varied or revoked, SIRA must update the register within 7 days after the direction is varied or revoked by SIRA or the Civil and Administrative Tribunal.\n> \n> **s 4E:** Ins 2022 (818), Sch 1\\[1\\]. Am 2024 No 47, Sch 1.23.","sortOrder":8},{"sectionNumber":"4F","sectionType":"section","heading":"Authorised officers—the Act, s 29B(6)","content":"#### 4F Authorised officers—the Act, s 29B(6)\n\n4F Authorised officers—the Act, s 29B(6)\n\n> For the Act, section 29B(6), definition of authorised officer, persons designated by SIRA as authorised officers for the purposes of the section are prescribed.\n> \n> **s 4F:** Ins 2022 (818), Sch 1\\[1\\].","sortOrder":9},{"sectionNumber":"5","sectionType":"section","heading":"Repeal and savings","content":"#### 5 Repeal and savings\n\n5 Repeal and savings\n\n> > (1) The [State Insurance and Care Governance Regulation 2015](/view/html/repealed/current/sl-2015-0530) is repealed.\n> \n> > (2) Any act, matter or thing that, immediately before the repeal of the [State Insurance and Care Governance Regulation 2015](/view/html/repealed/current/sl-2015-0530), had effect under that Regulation continues to have effect under this Regulation.","sortOrder":10},{"sectionNumber":"Schedule 1","sectionType":"schedule","heading":"Penalty notice offences","content":"# Schedule 1 Penalty notice offences\n\nSchedule 1 Penalty notice offences\n\n| Column 1 | Column 2 | Column 3 |\n| Provision | Penalty—individuals | Penalty—corporations |\n| Offences under the Act |\n| Section 26C(2) | $750 | $1,250 |\n| Section 26D(3) | $750 | $1,250 |\n\n**sch 1:** Ins 2022 (818), Sch 1\\[2\\].","sortOrder":11}],"analysis":{"flash_summary_failed":{"failed":true,"reason":"A positive credit balance is required for all requests, including BYOK, so fallback providers remain available. Add credits at https://vercel.com/d?to=%2F%5Bteam%5D%2F%7E%2Fai%3Fmodal%3Dtop-up to continue.","source":"analysis-cron"},"summary":{"complexity_score":3,"scope_assessment":{"changed":false,"description":"Based on the available metadata alone, there is no evidence of scope change from the regulation's original intent. The regulation appears to have been amended in December 2022 and August 2024, but without access to the operative provisions or an explanatory note, it is not possible to determine whether those amendments expanded or narrowed the regulation's original scope."},"complexity_factors":["Only metadata and status information was provided — the actual operative provisions are absent, making full analysis impossible","The regulation sits within a multi-layered governance structure involving multiple agencies (icare, SIRA) and the parent State Insurance and Care Governance Act 2015","Three separate versions exist (2021, 2022, 2024), suggesting incremental amendments that may interact in non-obvious ways","The staged repeal mechanism under the Subordinate Legislation Act 1989 adds a procedural layer to track","The subject matter (insurance and care governance) inherently involves complex regulatory and financial frameworks, though the document itself reveals little of that complexity"],"plain_english_summary":"The State Insurance and Care Governance Regulation 2021 (NSW) sets out how key bodies under the State Insurance and Care Governance Act 2015 — notably icare and SIRA — are to be governed and operate. In force since 28 May 2021 (amended Dec 2022 and Aug 2024) and due for automatic repeal 1 Sept 2026, it affects injured workers, CTP claimants, employers and the agencies managing billions in insurance and care funds, shaping how claims, fees and accountability are handled."},"issue_detection":{"absurdities":[],"contradictions":[]},"kimi_summary":{"content_quality":"ok","complexity_score":4,"scope_assessment":{"changed":true,"description":"The original 2021 Regulation was a straightforward machinery provision dealing with authorised persons and repeal/savings. The 2022 amendments (sections 4A-4F and Schedule 1) dramatically expanded scope to create an entire compliance and enforcement framework for 'relevant service providers', including a public naming register, penalty notices, and detailed procedural rules for directions and reviews. This transformed the instrument from simple administrative machinery into a substantive regulatory scheme for health provider oversight."},"complexity_factors":["Multiple insertion amendments (2022, 2024) creating a fragmented structure with sections marked 'Ins 2022 (818)' and 'Am 2024 No 47'","Heavy reliance on definitions in parent Act (State Insurance and Care Governance Act 2015) and cross-references to workers compensation and motor accidents legislation","Nested subsections with up to 4 levels of indentation (e.g., section 4A(1)(za)(i))","Conditional logic in review timeframes with multiple alternative triggers (section 4D(7))","Exception to exception in section 4A(2) excluding legal advice services from the administrative services definition","Incorporation of external statutory concepts by reference (Public Service employee, statutory officer, Health Services Act definitions)"],"plain_english_summary":"This Regulation sets out the operational details for how the State Insurance and Care Governance Act 2015 works in practice, particularly regarding oversight of health and rehabilitation service providers who treat injured workers and motor accident victims in New South Wales.\n\n**What it does:**\n\n*   **Identifies who can enforce the rules:** Public service employees and statutory officers are authorised to exercise powers under the Act.\n*   **Lists regulated services:** It specifies exactly which health and support services fall under SIRA's (State Insurance Regulatory Authority) oversight — everything from doctors, dentists and physiotherapists to counsellors, massage therapists, and even administrative services like handling referrals and medical records.\n*   **Exempts public health providers:** Public hospitals, local health districts, the Ambulance Service and certain other government health bodies are explicitly excluded from being regulated as \"relevant service providers.\"\n*   **Sets rules for compliance directions:** If a service provider breaks workers compensation or motor accidents laws, or fails to follow guidelines, SIRA can issue them a formal direction. The Regulation spells out how these directions must be delivered, what they must include (including reasons and review rights), how long they last, and how they can be varied.\n*   **Provides for internal review:** Service providers can ask SIRA to review certain directions within 28 days. SIRA must decide whether to confirm, vary or revoke the direction, and generally has 28 days to make that decision.\n*   **Creates a public register:** SIRA must keep a publicly available online register listing service providers who have been given directions, including what the direction was and when it took effect. This acts as a \"name and shame\" transparency mechanism.\n*   **Sets fines for non-compliance:** It establishes penalty notice amounts ($750 for individuals, $1,250 for corporations) for offences like failing to comply with information requests or ignoring compliance directions.\n\n**Who it affects:**\n\n*   Private health practitioners and service providers treating injured workers or motor accident victims\n*   SIRA and its authorised officers\n*   Injured people claiming workers compensation or motor accident benefits (indirectly, through better oversight of their treatment providers)\n\n**Why it matters:**\nThis Regulation gives SIRA practical tools to police the quality and integrity of services provided to injured people under the NSW workers compensation and motor accidents schemes. The public register creates accountability, while the penalty provisions give teeth to compliance directions. The 2022 amendments significantly expanded the Regulation's scope to cover administrative services and create a comprehensive compliance framework."},"flash_summary":{"complexity_score":3,"scope_assessment":{"changed":true,"description":"The Regulation repeals and replaces the 2015 Regulation and updates scope and procedural detail: it expressly lists relevant services and excludes certain public health bodies, clarifies how SIRA may give, vary and review directions, requires a public register (with amendment/removal powers), designates authorised officers and sets penalty notice amounts. A savings clause preserves existing effects where relevant."},"complexity_factors":["Extensive prescriptive lists (many named health and support services) that increase operational detail","Cross-references to the State Insurance and Care Governance Act and other NSW Acts for definitions and authority","Administrative procedure rules with fixed timelines for internal/administrative review and register updates","Discretion granted to SIRA to withhold, amend or remove register information and to vary directions","Penalty notice regime specifying distinct monetary amounts for individuals and corporations","Exclusions and interactions (eg. excluded relevant service providers and excluded administrative services) that affect scope of application"],"plain_english_summary":"This Regulation replaces the 2015 instrument and sets out who counts as authorised persons and which health and support activities count as ‘relevant services’ under the State Insurance and Care Governance Act. It gives SIRA power to issue directions to service providers, prescribes how those directions must be given and reviewed, requires a public register of directed providers, designates authorised officers, and lists penalty notice offences.\n\nSIRA decides and enforces directions; affected providers face compliance duties, potential public listing and fixed penalty amounts for specified breaches."}},"importantCases":[],"_links":{"self":"/api/acts/state-insurance-and-care-governance-regulation-2021","history":"/api/acts/state-insurance-and-care-governance-regulation-2021/history","analysis":"/api/acts/state-insurance-and-care-governance-regulation-2021/analysis","conflicts":"/api/acts/state-insurance-and-care-governance-regulation-2021/conflicts","importantCases":"/api/acts/state-insurance-and-care-governance-regulation-2021/important-cases","documents":"/api/acts/state-insurance-and-care-governance-regulation-2021/documents"}}