Part 3Prescribed pattern of services

## Part 1—Introductory #### 1 Name of Regulations These Regulations are the Health Insurance (Professional Services Review) Regulations 1999. #### 3 Definition In these Regulations: > Act means the Health Insurance Act 1973. > Note: Several other words and expressions used in these Regulations have the meaning given by the Act. The following are examples of words and expressions defined in Part VAA of the Act:  adequate and contemporaneous records  inappropriate practice  person under review  practitioner  profession  relevant period  service. ## Part 2—Adequate and contemporaneous records #### 4 Purpose of this Part This Part sets out the standards to be met in order that a practitioner’s records of the rendering or initiation of services be adequate and contemporaneous records. > Note: See subsection 82(3) of the Act for the significance of adequate and contemporaneous records. #### 5 An adequate record For the definition of adequate and contemporaneous records in section 81 of the Act, the standard to be met in order that a record of service rendered or initiated be adequate is that: (a) the record clearly identify the name of the patient; and (b) the record contain a separate entry for each attendance by the patient for a service and the date on which the service was rendered or initiated; and (c) each entry provide clinical information adequate to explain the type of service rendered or initiated; and (d) each entry be sufficiently comprehensible that another practitioner, relying on the record, can effectively undertake the patient’s ongoing care. #### 6 A contemporaneous record For the definition of adequate and contemporaneous records in section 81 of the Act, the standard to be met in order that a record of a service rendered or initiated be contemporaneous, is that record must be completed: (a) at the time the practitioner rendered or initiated the service; or (b) as soon as practicable after the service was rendered or initiated by the practitioner. ## Part 3—Prescribed pattern of services #### 7 Definition For this Part: > professional attendance means a service of a kind mentioned in group A1, A2, A5, A6, A7, A9, A11, A13, A14, A15, A16, A17, A18, A19, A20, A21, A22 or A23 of Part 2 of the general medical services table. #### 8 Purpose of this Part This Part prescribes the circumstances in which services rendered or initiated by a practitioner constitute a prescribed pattern of services for Part VAA of the Act. > Note: See section 82 of the Act for how a prescribed pattern of services may constitute engaging in inappropriate practice. #### 9 Practitioners affected by these Regulations For section 82A of the Act, the following groups of practitioners in the profession of medicine are groups to which these Regulations apply: (a) general practitioners; (b) other medical practitioners rendering professional attendances. #### 10 Circumstances constituting a prescribed pattern For section 82A of the Act, the circumstances in which services that are professional attendances constitute a prescribed pattern of services are that 80 or more such services are rendered on each of 20 or more days in a 12 month period. #### 11 Exceptional circumstances For subsection 82(1D) of the Act, the following circumstances are declared as constituting exceptional circumstances: (a) an unusual occurrence causing an unusual level of need for professional attendances; (b) an absence of other medical services, for patients of the person under review during the relevant period, having regard to: (i) the location of the practice of the person under review; and (ii) characteristics of the patients of the person under review. ## Part 3A—Professional Services Review Committees #### 11A Allowances for witnesses at hearings (1) This section is made for the purposes of subsection 106C(1) of the Act and deals with allowances for expenses in respect of attendance by a person summoned to appear as a witness at a hearing before a Professional Service Review Committee. Kinds of allowances (2) The allowances for a witness are the following: (a) attendance allowance in accordance with subsection (3) or (4) as applicable; (b) travel allowance in accordance with subsection (5). Amount of attendance allowance (3) For a witness attending because of the witness’ professional, scientific or other special skill or knowledge the amount of attendance allowance is equal to the witness’ actual fees for preparing to give evidence and of attending to give evidence. (4) For a witness other than a witness mentioned in subsection (3), the amount of attendance allowance is equal to: (a) if the witness is paid by wages—any wages actually lost because of the attendance; or (b) if the witness is paid by fees—any fees actually lost because of the attendance; up to a maximum of $527 per day. Amount of travel allowance (5) The amount of travel allowance for a witness is a reasonable amount, determined by the Professional Services Review Committee, for: (a) transport to and from the hearing; and (b) if the witness is required to be absent overnight from the witness’ usual place of residence—meals and accommodation during the absence. ## Part 4—Appropriate person or body for person under review #### 12 Appropriate person or body for conduct involving significant threat to life or health For subsection 106XA(4) of the Act, the appropriate person or body for a person under review is a person or body specified in Schedule 1 that has the power to take action against the person under review in relation to any conduct by that person that has caused, is causing, or is likely to cause, a significant threat to the life or health of another person. #### 13 Appropriate body for non‑compliance with professional standards (1) For paragraph 106XB(3)(a) of the Act, the appropriate body for a person under review who is a general practitioner is a body specified in Part 1 of Schedule 1 that: (a) is responsible for registering general practitioners or for regulating the practice of the profession; and (b) has the power to take action against the person in relation to the person’s failure to comply with professional standards. (2) For paragraph 106XB(3)(b) of the Act, the appropriate body for a person under review who is a practitioner other than a general practitioner is a body specified in Part 2 of Schedule 1 that: (a) is responsible for registering practitioners for practice in the profession or specialty to which the practitioner belongs or for regulating the practice of that profession or specialty; and (b) has the power to take action against the person in relation to the person’s failure to comply with professional standards.