The regulation introduces or refines several concepts whose scope directly determines the regulatory burden on private health service providers.

Relevant services are defined exhaustively in section 4A(1) by a list of 28 categories (a) through (zc). The list is unusually broad. It covers every major allied health discipline (chiropractic, dietetics, exercise physiology, massage therapy, occupational therapy, optometry, osteopathy, physiotherapy, podiatry, psychology, social work, speech therapy) plus medical radiation practice, nursing, pharmaceutical services, patient transport, private hospital and day surgery services, and workplace rehabilitation. It also includes "services provided to injured persons relating to the provision and maintenance of aids, appliances or prostheses" - artificial body parts, mobility aids, equipment for daily living. Domestic assistance services (cleaning, laundry, lawn care, transport) are included. Importantly, subparagraph (za) captures services provided by a health practitioner that do not involve treatment: medical opinions on injury cause or treatment, permanent impairment assessments, peer reviews, and rehabilitation coordination. Subparagraph (zb) catches "administrative services relating to" referrals, medical evidence production, access to medical documents, and centralisation of appointments. This is a very wide net. The only express carve-out is for administrative services relating to the provision of legal advice to, or representation of, an injured person regarding a claim or dispute under workers compensation or motor accidents legislation (section 4A(2)). That means practice managers, medical records companies, scheduling platforms, and referral coordination services caught up in the workers compensation system are all potentially subject to SIRA directions.

Relevant service providers are defined by exclusion in section 4B. The following are not relevant service providers: a public hospital, a local health district, a specialty network governed health corporation, the Ambulance Service of NSW, the Health Administration Corporation, and the division of the Ministry of Health known as Health Protection NSW. Every other person or entity providing a relevant service to an injured person falls within the definition. This means private hospitals, private clinics, sole practitioner allied health providers, domestic assistance agencies, and workplace rehabilitation firms are all covered. The effect is to subject the private health services market supporting the workers compensation and motor accidents schemes to a specific regulatory direction power that does not apply to public health providers.

Directions are the central regulatory tool. The regulation distinguishes between two types of directions under section 26D of the Act. Directions under section 26D(1)(a) or (b) are "service delivery directions" - they can require a provider to obtain SIRA's approval before providing a relevant service, impose conditions, or restrict the provider's ability to charge for services. Directions under section 26D(1)(c) or (d) are "compliance directions" - they can require a provider to take specified action to comply with the law or to stop providing a service. The regulation's procedural requirements apply to both types but the review rights differ (internal review only for (a) and (b); administrative review to NCAT for (c) and (d)). Grounds for issuing any direction (section 4C(3)) are: non-compliance with the workers compensation or motor accidents legislation, non-compliance with guidelines issued under that legislation or under section 26E of the Act, or referral to or investigation by a relevant clinical, professional or accreditation body. The last ground is notable because it does not require a finding of misconduct - only that the provider is under investigation or has been referred. A direction takes effect on the day it is given or a later day specified (section 4C(4)). It remains in force until the specified end date unless earlier revoked by SIRA. SIRA may also vary a direction by written notice (section 4C(5)).

Internal review is available only for directions given under section 26D(1)(a) or (b) of the Act (service delivery restrictions). The provider must apply in writing within 28 days (or longer if SIRA allows) in the form and manner determined by SIRA (section 4D(1)-(2)). SIRA may request additional information and the provider must supply it within the specified period. SIRA then has 28 days from receipt of the application (or receipt of additional information if requested) to decide, or longer if SIRA has given notice that additional time is needed. The decision may confirm, vary, or revoke the direction. Critically, the direction remains in force during the internal review (section 4D(9)). There is no appeal from an internal review determination under this regulation; the review is conducted by SIRA itself, not an independent body.

Register of directed service providers is mandated by section 4E to be in a form determined by SIRA and made freely available on SIRA's website. It must include the provider's name, ABN or AHPRA registration number, SIRA provider number (if applicable), the relevant services provided, and information about the direction including what it was and when it took effect. SIRA may exclude information if it considers it appropriate not to include it. SIRA may also amend or remove information if it considers the information erroneous or misleading, or for another reason SIRA considers appropriate (a wide discretion). If a direction is varied or revoked, SIRA must update the register within 7 days.

Authorised officers for the purposes of section 29B(6) of the Act (which deals with penalty notices) are prescribed as persons designated by SIRA as authorised officers (section 4F).

Penalty notice offences are set out in Schedule 1. Two offences: section 26C(2) of the Act (likely failure to provide information, documents, or records as required by an authorised person) and section 26D(3) of the Act (failure to comply with a direction). Penalties are $750 for an individual and $1,250 for a corporation per offence. This is a fixed penalty that avoids court proceedings; the recipient can choose to pay or elect to have the matter dealt with by a court (where a higher maximum penalty under the Act might apply).

The regulation directly affects every private sector health and support service provider that treats or assists an injured person under New South Wales's workers compensation or motor accidents schemes. This includes medical practitioners (general practitioners, specialists), dentists, allied health professionals (physiotherapists, chiropractors, psychologists, occupational therapists, speech pathologists, exercise physiologists, dietitians, podiatrists, osteopaths, optometrists, audiologists, Chinese medicine practitioners), nurses, pharmacists, private hospitals and day surgery centres, providers of aids and prostheses (including mobility aids and artificial limbs), domestic assistance providers (cleaning, gardening, transport services), workplace rehabilitation providers, rehabilitation services generally, massage therapists, social workers, counsellors, providers of medical radiation practice services, and providers of patient transport services. Also caught are providers of administrative services related to referrals, medical evidence, and appointment coordination (unless those services are provided in connection with legal advice or representation). The list is so broad that it is difficult to identify any private practitioner involved in the workers compensation system who is not a relevant service provider.

Entities that are expressly excluded are public hospitals, local health districts, specialty network governed health corporations, the Ambulance Service of NSW, the Health Administration Corporation, and Health Protection NSW. This exclusion of public providers creates a regulatory asymmetry: private practitioners face a direction power and public register that equivalent public providers do not. The effect is to concentrate compliance risk on the private sector.

Injured persons are indirectly affected because the direction power can restrict their choice of provider. If a provider is directed to stop providing services or to obtain SIRA approval before providing them, the injured person may lose continuity of care or face delays. The public register may also serve as a consumer information tool, potentially steering patients away from providers who have been directed.

Insurers in the workers compensation and motor accidents schemes are affected because they rely on a network of providers to deliver services to claimants. Directions that restrict or remove a provider from the market reduce the available supply, potentially affecting access, wait times, and costs. Insurers may also face pressure to avoid engaging directed providers.

SIRA itself is the regulator that exercises the direction power, conducts internal reviews, maintains the register, designates authorised officers, and issues penalty notices. The regulation imposes administrative obligations on SIRA: giving proper notice, considering review applications within 28 days, updating the register within 7 days of a variation or revocation.

The regulation creates duties for service providers and rights that are contingent on the type of direction issued.

Duties. A relevant service provider must comply with a direction given under section 26D of the Act. Non-compliance is an offence under section 26D(3) of the Act, punishable by a penalty notice of $750 (individual) or $1,250 (corporation) or potentially a higher court-imposed penalty. The provider must also comply with a request for information from an authorised person; failure is an offence under section 26C(2) of the Act, also subject to the same penalty notice amounts. If a provider receives a direction, it must comply from the date it takes effect - no grace period unless specified. If SIRA requests additional information during an internal review, the provider must provide it within the specified period (section 4D(5)). There is a duty to maintain accurate contact details for receiving electronic directions: if SIRA transmits a direction to an address the provider specified for that purpose (section 4C(1)(b)), the direction is validly given.

Rights. When a direction is given, the provider is entitled to receive written reasons for the direction and a statement of review rights (section 4C(2)). For a direction under section 26D(1)(a) or (b) - service delivery restrictions - the provider has a right to apply for an internal review within 28 days (section 4D(1)). That review is conducted by SIRA itself, not an independent tribunal. The provider has the right to provide additional information if requested, but no right to an oral hearing. For a direction under section 26D(1)(c) or (d) - compliance directions - the provider is not entitled to an internal review under this regulation. Instead, the direction must state that the provider is entitled to an administrative review under section 26F of the Act, which is conducted by the Civil and Administrative Tribunal (NCAT). The provider also has the right to have the public register updated within 7 days if a direction is varied or revoked (section 4E(4)), though there is no mechanism to compel SIRA to act beyond potential judicial review.

SIRA's duties. SIRA must give directions with reasons and review rights. It must conduct internal reviews within 28 days (or longer if notice given). It must maintain the register and update it within 7 days of a variation or revocation. SIRA may, but is not required to, include information on the register; it has discretion to omit information if appropriate. SIRA may amend or remove information if erroneous or misleading, or for another reason it considers appropriate (section 4E(3)).

The regulation establishes a penalty notice regime for two specific offences under the State Insurance and Care Governance Act 2015. The amounts in Schedule 1 are $750 for an individual and $1,250 for a corporation for both section 26C(2) and section 26D(3). A penalty notice gives the recipient the option to pay the specified amount and have the matter dealt with without a court appearance. If the recipient does not pay, the matter may be referred to a court, where a higher maximum penalty could be imposed under the Act (the regulation does not state those maxima, but they would be set by the Act itself). The penalty notice can only be issued by an authorised officer as prescribed by section 4F (persons designated by SIRA). Section 26D(3) of the Act is the offence of failing to comply with a direction. Section 26C(2) of the Act is the offence of failing to provide information, documents, or records when required by an authorised person. The regulation itself does not create any new offences; it only sets the penalty notice amounts for existing Act offences.

Enforcement beyond penalty notices is not detailed in the regulation but flows from the Act. A direction is binding and non-compliance is an ongoing offence. SIRA could also seek injunctive relief or other orders from a court. The public register operates as a reputational enforcement tool: a provider named on the register is publicly identified as having been directed, which may deter insurers or patients from engaging them. There is no provision for removal of a provider from the register based on expiration of a direction unless SIRA updates it; the direction remains on the register until it is varied or revoked and SIRA updates it.

The regulation sits under the State Insurance and Care Governance Act 2015 and gives effect to its provisions. Section 26 of that Act allows authorised persons to require information; this regulation prescribes who those authorised persons are (public service employees and statutory officers). Section 26A of the Act defines "relevant service" and "relevant service provider" by reference to the regulation; this regulation fills those definitions. Section 26D of the Act gives SIRA power to give directions; this regulation sets the procedural requirements (manner of giving, reasons, review rights, grounds). Section 26D(4)(f) of the Act allows for internal review; this regulation provides the mechanism. Section 26G(2) of the Act requires a register; this regulation prescribes its content and publication. Section 29B(6) of the Act deals with penalty notices; this regulation designates authorised officers and sets penalty amounts.

The regulation interacts with the workers compensation legislation (Workplace Injury Management and Workers Compensation Act 1998 and Workers Compensation Act 1987) and the motor accidents legislation (Motor Accidents Compensation Act 1999 and Motor Accident Injuries Act 2017) in two ways. First, the definition of "relevant services" is expressly stated to be services provided to injured persons under the workers compensation and motor accidents legislation. Second, a direction can be given if the provider has not complied with a provision of that legislation or with guidelines issued under it (section 4C(3)(a) and (b)). The regulation thus ties the direction power directly to compliance with those specific statutes and guidelines.

The regulation interacts with the Health Services Act 1997 by adopting its definitions for the excluded entities in section 4B(2). Words and expressions used in that section have the same meaning as in the Health Services Act. This means "public hospital", "local health district", "specialty network governed health corporation", and other terms are defined by reference to that Act.

The regulation interacts with the Government Sector Employment Act 2013 for the definition of "Public Service employee" in section 4. The Interpretation Act 1987 applies generally.

The regulation repealed and replaced the State Insurance and Care Governance Regulation 2015, with a savings provision (section 5(2)) ensuring any act, matter or thing that had effect under the old regulation continues under the new one.

The regulation was originally made on 1 September 2021, published on the NSW legislation website on that date, and commenced on that date. It repealed and replaced the 2015 regulation. In its original form it appears to have contained only sections 1-5 (name, commencement, definitions, authorised persons, repeal and savings) and no schedule. The substantive expansion came with the State Insurance and Care Governance Amendment (Directions) Regulation 2022 (NSW Regulation 818 of 2022), which inserted sections 4A through 4F and Schedule 1. That amendment was made on 18 November 2022 and commenced on that date (or on publication). It introduced the entire framework for relevant services, relevant service providers (excluding public entities), directions procedures, internal review, the register, authorised officers for penalty notices, and the penalty notice schedule. This was a significant addition that transformed the regulation from a purely administrative instrument into a detailed regulatory code governing private service providers in the workers compensation and motor accidents schemes.

A further amendment was made in 2024 by the State Insurance and Care Governance Amendment (Miscellaneous) Regulation 2024 (No 47 of 2024, Sch 1.23). That amendment appears to have made a minor textual change to section 4E(2) - the wording was adjusted (possibly adding a non-breaking space or similar) but the substance remains: the register must include the provider's name, ABN or AHPRA number, SIRA provider number, services, and direction details unless SIRA considers it inappropriate. The amendment history note on the legislation website records "Am 2024 No 47, Sch 1.23" for section 4E.

The source does not refer to any litigation under this regulation. The regulation is recent (2021, with major amendments in 2022) and the direction powers are relatively new. However, the potential for litigation is real. A provider who receives a direction under section 26D(1)(c) or (d) of the Act has a right to administrative review by the Civil and Administrative Tribunal under section 26F of the Act. No reported decisions of NCAT are mentioned in the regulation. Providers may also seek judicial review of SIRA's decisions (e.g., on natural justice grounds, or if the direction was beyond power). The internal review process under section 4D is conducted by SIRA itself, which may raise concerns about bias or inadequate review; however, the regulation does not preclude subsequent recourse to NCAT or the courts. The grounds for giving a direction include that the provider is "under investigation by a relevant clinical, professional or accreditation body" (section 4C(3)(c)) - this is a low threshold that does not require a finding of wrongdoing, which could be challenged on procedural fairness grounds. No cases are cited in the regulation itself.

The regulation contains several features that may catch providers unprepared.

Extraordinary breadth of "relevant services". The definition in section 4A covers not only traditional clinical services but also "administrative services relating to" referrals, medical evidence, access to documents, and centralisation or coordination of referrals and appointments (section 4A(1)(zb)). The only carve-out is for legal advice and representation. This potentially catches practice managers, medical records companies, appointment scheduling platforms, and referral coordinators who are not themselves health practitioners but who facilitate services to injured persons. They would be "relevant service providers" (since they are not excluded under section 4B) and could be directed.

No finding of wrongdoing required for direction. A direction may be given if the provider "has been referred to, or is under investigation by, a relevant clinical, professional or accreditation body" (section 4C(3)(c)). This does not require any breach of law or guidelines. A mere referral or investigation, even if ultimately unfounded, is enough for SIRA to impose restrictions. The provider bears the burden of seeking review.

Direction remains in force during internal review. Section 4D(9) states: "To avoid doubt, a direction that is the subject of an internal review remains in force until SIRA determines the internal review." This means even if the provider genuinely believes the direction is wrong, they must comply while the review is pending. Non-compliance during that period is an offence.

Internal review only for service delivery directions. Directions under section 26D(1)(a) or (b) (restrictions on providing services, requiring approval, conditions on charging) are eligible for internal review. Directions under (c) or (d) (requiring compliance or stopping services) are not. Those require an administrative review under section 26F of the Act, which may involve a more formal process at NCAT. The regulation does not prescribe that process; it only states that the direction must inform the provider of that right (section 4C(2)(b)(ii)). The provider must then navigate the Act and NCAT rules.

Register is public and persistent. The register is mandatory and free on SIRA's website (section 4E(1)(b)). It includes the provider's name and direction details. Even if the direction is later varied or revoked, the register is only updated within 7 days - it does not say the history is removed. SIRA may remove information if it considers it erroneous or misleading, or for another reason it considers appropriate, but that is discretionary. The reputational damage from being listed, even temporarily, may be significant. There is no right to be removed if the direction is found to have been wrongly issued; SIRA's discretion is broad.

No time limit on how long a direction can last. Section 4C(4)(a) says a direction "takes effect on the day on which the direction is given or a later day specified", and (b) says it "remains in force until the day, if any, specified in the direction unless sooner revoked by SIRA". The direction need not specify an end date. It could be indefinite. The provider's only recourse is internal review (for (a)(b) directions) or administrative review (for (c)(d) directions), or seeking revocation by SIRA.

Penalty notice amounts are low but multiply. $750 for an individual, $1,250 for a corporation per offence. For a practice with multiple practitioners or multiple breaches, the total could add up. But the low amounts may not deter large providers; they function more as a summary enforcement tool.

No requirement for SIRA to consider less restrictive alternatives. The regulation does not require SIRA to consider whether a warning, education, or lesser measure would suffice before issuing a direction. The grounds are binary: non-compliance or investigation triggers the power.

Public providers excluded; private providers caught. The exclusion in section 4B of public hospitals and related entities means that equivalent services provided by the public system are not subject to this direction framework. This creates an uneven playing field.

For a service provider covered by this regulation, compliance involves a series of affirmative steps.

1. Determine if you are a relevant service provider. Review the exhaustive list in section 4A. If you provide any of those services to an injured person under the workers compensation or motor accidents legislation, you are likely covered unless you fall within the narrow exclusions in section 4B (public hospitals, local health districts, etc.). Even if you only provide administrative services (scheduling, records, referrals) you may be covered unless those services relate to legal advice or representation.

2. Know the legislative and guideline framework. A direction can be triggered by non-compliance with the workers compensation or motor accidents legislation or guidelines issued under that legislation or under section 26E of the State Insurance and Care Governance Act. You must be familiar with the obligations under the Workplace Injury Management and Workers Compensation Act 1998, the Workers Compensation Act 1987, and the relevant motor accidents legislation. You must also know any guidelines issued by SIRA under section 26E of the Act (these are separate from the regulation and not reproduced here). Ignorance of the law is no defence.

3. Maintain accurate contact details. Directions can be given electronically to an address you have specified for receiving directions (section 4C(1)(b)). You should designate a reliable email address or electronic service address for this purpose and keep it current. Check it regularly.

4. Respond promptly to information requests. If an authorised person (a public service employee or statutory officer) requests information under section 26 of the Act, you must comply. Failure is an offence under section 26C(2) of the Act, subject to penalty notice. Have a process for handling such requests.

5. If you receive a direction, read it carefully. Note the type of direction (whether under section 26D(1)(a), (b), (c) or (d)), the effective date, the reasons, and the review rights stated. Check if the direction specifies an end date. Comply immediately; the direction is in force from the effective date unless you successfully challenge it.

6. Decide whether to seek review. For directions under (a) or (b), you have 28 days to apply for an internal review under section 4D. The application must be written, in the form and manner determined by SIRA. You should gather evidence to support your case (e.g., evidence of compliance, that the investigation is unfounded). Note that the direction remains in force during the review. For directions under (c) or (d), the direction must state your right to an administrative review under section 26F of the Act - you should seek legal advice on pursuing that.

7. Monitor the public register. After a direction is given, you should check the register on SIRA's website to ensure the information is correct. If it is erroneous or misleading, you can request SIRA to amend or remove it under section 4E(3). If a direction is varied or revoked, ensure SIRA updates the register within 7 days.

8. Maintain compliance records. Keep records of your compliance with workers compensation and motor accidents legislation, any guidelines, and any directions. This will be useful if you are investigated or if you seek review. Have a system for tracking expiry dates of directions.

9. Train staff. If you are a practice or organisation, ensure relevant staff understand the obligations, the consequences of non-compliance, and how to respond to SIRA communications.

10. Seek legal advice. The direction power is broad, the internal review is internal, and the grounds for directions include mere investigation. If you are under investigation by a professional body, proactively consider whether to notify SIRA or seek guidance. Legal advice is prudent before responding to any information request or direction, especially given the penalty notice consequences.