HEALTH LEGISLATION (PROFESSIONAL SERVICES REVIEW) AMENDMENT ACT 1994 No. 22, 1994
HEALTH LEGISLATION (PROFESSIONAL SERVICES REVIEW) AMENDMENT ACT 1994 No. 22 of 1994 - TABLE OF PROVISIONS
TABLE OF PROVISIONS Section PART 1-PRELIMINARY 1. Short title 2. Commencement 3. Object of this Act PART 2-AMENDMENTS OF THE HEALTH INSURANCE ACT 1973 4. Principal Act 5. Repeal of Division 3 and 3A of Part V 6. Insertion of new Part: PART VAA-THE PROFESSIONAL SERVICES REVIEW SCHEME Division 1-Preliminary 80. Outline of this Part 81. Definitions 82. Definitions of inappropriate practice Division 2-The Director of Professional Services Review and the Professional Services Review Panel 83. The Director of Professional Services Review 84. The Professional Services Review Panel 85. Deputy Directors of Professional Services Review Division 3-Referrals by the Health Insurance Commission 86. Commission may refer matters to the Director 87. Content and form of referrals 88. Procedure for notifying referrals 89. Deadline for deciding on referrals 90. Director may consult on decisions 91. Dismissing referrals as lacking sufficient foundation 92. Dismissing referrals if partial disqualification is agreed 93. Decisions to set up Committees 94. Notice of decisions on referrals Division 4-Professional Services Review Committees Subdivision A-Constitution of Committees 95. Constitution of Committees 96. Challenging appointments to Committees Subdivision B-Proceedings of Committees 97. Meetings 98. Conduct of meetings 99. Other procedural matters relating to meetings 100. Consultants 101. Hearings 102. Notice of hearings 103. Rights of persons under review at hearings 104. Requiring persons under review to give evidence etc. 105. Consequences of not complying with requirements 106. Conduct of hearings 106A. Evidence at hearings 106B. Summons to give evidence etc. 106C. Allowances for witnesses at hearings 106D. Failure to attend 106E. Refusal to be sworn or to answer questions 106F. Protection of Committee members, representatives and witnesses at hearings Subdivision C-Findings based on statistical sampling 106G. Application of this Subdivision 106H. Committees may make findings based on samples 106J. Rights of persons under review concerning samples 106K. Directions on production etc. of samples Subdivision D-Reporting by Committees 106L. Reports to the Determining Officer 106M. Deadline for reporting 106N. Suspension of proceedings if fraud is suspected 106P. Referring matters to other regulatory bodies Division 5-Determinations 106Q. The Determining Officer 106R. Copies of Committee reports to be given to persons under review 106S. Draft determinations relating to persons under review 106T. Final determinations relating to persons under review 106U. Content of determinations 106V. When final determinations take effect 106W. Notification of final determination 106X. Notification of the Chairperson of Medicare Participation Review Committees Division 6-Provisions relating to the Director, Panel members, staff and consultants Subdivision A-The Director 106Y. Term of office
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106Z. Director's terms and conditions of appointment 106ZA. Outside employment 106ZB. Leave of absence 106ZC. Resignation 106ZD. Termination of the Director's appointment 106ZE. Acting appointments 106ZF. Remuneration and allowances Subdivision B-Panel members 106ZG. Term of office 106ZH. Panel member's terms and conditions of appointment 106ZI. Outside employment 106ZJ. Resignation 106ZK. Termination of a Panel member's appointment 106ZL. Remuneration and allowances Subdivision C-Staff and consultants 106ZM. Employment of staff 106ZN. Arrangements with other Commonwealth bodies 106ZP. Engagement of consultants Division 7-Miscellaneous 106ZQ. Annual report 106ZR. Disclosure of Committee deliberations etc. 7. Further amendments of the Principal Act PART 3-AMENDMENTS OF THE NATIONAL HEALTH ACT 1953 8. Principal Act 9. Suspension or revocation of approval PART 4-TRANSITIONAL PROVISIONS 10. Repeal of Divisions 2 and 2AA of Part VIII 11. Definitions 12. Medical Services Committees of Inquiry and Optometrical Services Committees of Inquiry 13. Determinations under sections 106 and 106FK 14. Regulations establishing other Committees 15. Medical Services Committees of Inquiry (Pharmaceutical Benefits) and Dental Services Committees of Inquiry SCHEDULE FURTHER AMENDMENTS OF THE HEALTH INSURANCE ACT 1973 HEALTH LEGISLATION (PROFESSIONAL SERVICES REVIEW) AMENDMENT ACT 1994 No. 22 of 1994 - LONG TITLE
An Act to amend the Health Insurance Act 1973, and for related purposes HEALTH LEGISLATION (PROFESSIONAL SERVICES REVIEW) AMENDMENT ACT 1994 No. 22 of 1994 - PART 1 PART 1-PRELIMINARY
HEALTH LEGISLATION (PROFESSIONAL SERVICES REVIEW) AMENDMENT ACT 1994 No. 22 of 1994 - SECT 1 Short title
(Assented to 16 February 1994) 1. This Act may be cited as the Health Legislation (Professional Services Review) Amendment Act 1994. (Minister's second reading speech made in- House of Representatives on 30 September 1993 Senate on 21 October 1993) HEALTH LEGISLATION (PROFESSIONAL SERVICES REVIEW) AMENDMENT ACT 1994 No. 22 of 1994 - SECT 2 Commencement
2. This Act commences on 1 July 1994. HEALTH LEGISLATION (PROFESSIONAL SERVICES REVIEW) AMENDMENT ACT 1994 No. 22 of 1994 - SECT 3 Object of this Act
3. The object of this Act is to create a new professional services review scheme under the Health Insurance Act 1973, setting out, in particular: (a) the process by which people are found to have engaged in inappropriate practice; and (b) the action that may be taken against them. HEALTH LEGISLATION (PROFESSIONAL SERVICES REVIEW) AMENDMENT ACT 1994 No. 22 of 1994 - PART 2 PART 2-AMENDMENTS OF THE HEALTH INSURANCE ACT 1973
HEALTH LEGISLATION (PROFESSIONAL SERVICES REVIEW) AMENDMENT ACT 1994 No. 22 of 1994 - SECT 4 Principal Act
4. In this Part, "Principal Act" means the Health Insurance Act 1973.*1* *1* No. 42, 1974, as amended. For previous amendments, see No. 58, 1975; Nos. 59, 91, 101, 109 and 157, 1976; No. 75, 1977; Nos. 36, 89 and 133, 1978; Nos. 53 and 123, 1979; No. 132, 1980; Nos. 118 and 176, 1981; Nos. 49, 80 and 112, 1982; Nos. 54 and 139, 1983; Nos. 15, 46, 63, 120, 135 and 165, 1984; Nos. 24, 65, 70, 95 and 167, 1985; Nos. 28, 75 and 94, 1986; Nos. 44, 131, 132 and 141, 1987; Nos. 85, 87, 99 and 155, 1988; Nos. 59, 84, 95 and 164, 1989; Nos. 3, 106 and 141, 1990; Nos. 6, 57, 68, 70, 73, 84, 116, 141, 171, 172, 175, 190, 193 and 211, 1991; Nos. 88, 136, 192, 204, 226, 229 and 230, 1992; No. 76, 1993; and No. 12, 1994.
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HEALTH LEGISLATION (PROFESSIONAL SERVICES REVIEW) AMENDMENT ACT 1994 No. 22 of 1994 - SECT 5 Repeal of Divisions 3 and 3A of Part V
5. Divisions 3 and 3A of Part V of the Principal Act are repealed. HEALTH LEGISLATION (PROFESSIONAL SERVICES REVIEW) AMENDMENT ACT 1994 No. 22 of 1994 - SECT 6 Insertion of new Part
6. After Part V of the Principal Act, the following Part is inserted: "PART VAA-THE PROFESSIONAL SERVICES REVIEW SCHEME "Division 1-Preliminary Outline of this Part "80.(1) This Part creates a scheme under which a person's conduct can be examined to ascertain whether inappropriate practice (see section 82) is involved. It also provides for action that can be taken in response to inappropriate practice. "(2) Division 2 creates the administrative structure for reviewing conduct. It consists of the Director of Professional Services Review and the Professional Services Review Panel (including Deputy Directors of Professional Services Review). "(3) Division 3 is about referral of a person's conduct for review. It provides for the Director to decide whether to set up a Professional Services Review Committee to consider the conduct. "(4) Division 4 is about Professional Services Review Committees. It deals with the following: (a) the membership of Committees (Subdivision A); (b) how Committees reach their decisions (Subdivision B); (c) in particular, how Committees may use samples of services to base their findings (Subdivision C); (d) how Committees report their findings (Subdivision D). "(5) Division 5 provides for the Determining Officer to make determinations to deal with inappropriate practice found by Committees. It also contains a link to the Medicare Participation Review Committee process in Part VB for some cases. "(6) Division 6 contains machinery provisions relating to the Director of Professional Services Review, members of the Professional Services Review Panel, and arrangements for staff and consultants. "(7) Division 7 deals with miscellaneous matters. Definitions "81.(1) In this Part, unless the contrary intention appears: 'AMA' means the Australian Medical Association; 'Chairperson' means the Chairperson of a particular Committee; 'Committee' means a Professional Services Review Committee set up under section 93; 'Committee member' means a member of a Committee; 'Deputy Director' means a Deputy Director of Professional Services Review appointed under section 85; 'Determining Officer' means the Determining Officer appointed under section 106Q; 'Director' means the Director of Professional Services Review appointed under section 83; 'inappropriate practice' has the meanings given in section 82; 'Panel' means the Professional Services Review Panel established under subsection 84(1); 'Panel member' means a member of the Panel appointed under subsection 84(2); 'person under review' means a person whose conduct is the subject of a referral, and, in relation to a particular referral, means the person whose conduct is the subject of that referral; 'pharmaceutical benefit' has the same meaning as it has for the purposes of Part VII of the National Health Act 1953; 'practitioner' means: (a) a medical practitioner; or (b) a dental practitioner; or (c) a participating optometrist (other than the Commonwealth, a State, the Australian Capital Territory, the Northern Territory or an authority, being a corporation, established by a law of the Commonwealth, a State or an internal Territory); or (d) an optometrist other than a participating optometrist; or (e) a chiropractor; or (f) a physiotherapist; or (g) a podiatrist; 'profession' means the group of persons engaged in one of the following vocations:
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(a) medicine; (b) dentistry; (c) optometry; (d) chiropractic; (e) physiotherapy; (f) podiatry; 'referral' means a matter referred to the Director under section 86; 'referred services' means the services to which a particular referral relates; 'service' means: (a) a service for which, at the time it was rendered or initiated, medicare benefit was payable; or (b) a prescribing or dispensing of a pharmaceutical benefit by a medical practitioner or a dental practitioner; 'specialist', in relation to a particular specialty, includes (except for the purposes of section 95) a consultant physician in that specialty. "(2) For the purposes of this Part: (a) general medical practice is taken to be a specialty; and (b) medical practitioners practising in general medical practice are taken to be specialists in that specialty. Definitions of inappropriate practice "82.(1) A practitioner engages in inappropriate practice if the practitioner's conduct in connection with rendering or initiating services is such that a Committee could reasonably conclude that: (a) if the practitioner is a specialist-the conduct would be unacceptable to the general body of the members of the speciality in which the practitioner was practising when he or she rendered or initiated the services; or (b) if the practitioner is not a specialist-the conduct would be unacceptable to the general body of the members of the profession in which the practitioner was practising when he or she rendered or initiated the services. "(2) A person (including a practitioner) engages in inappropriate practice if the person: (a) knowingly, recklessly or negligently causes, or knowingly, recklessly or negligently permits, a practitioner employed by the person to engage in conduct that constitutes inappropriate practice by the practitioner within the meaning of subsection (1); or (b) is an officer of a body corporate and knowingly, recklessly or negligently causes, or knowingly, recklessly or negligently permits, a practitioner employed by the body corporate to engage in conduct that constitutes inappropriate practice by the practitioner within the meaning of subsection (1). "Division 2-The Director of Professional Services Review and the Professional Services Review Panel The Director of Professional Services Review "83.(1) The Minister may appoint a medical practitioner to be the Director of Professional Services Review. "(2) The Minister must not appoint a person unless the AMA has agreed to the appointment. The Professional Services Review Panel "84.(1) The Professional Services Review Panel is established. "(2) It consists of practitioners appointed by the Minister. "(3) Before appointing a medical practitioner to be a Panel member, the Minister must consult the AMA. The Minister must make an arrangement with the AMA under which the AMA consults other specified organisations and associations before advising the Minister on the appointment. "(4) Before appointing a practitioner other than a medical practitioner to be a Panel member, the Minister must consult such organisations and associations, representing the interests of the profession to which the practitioner belongs, as the Minister thinks appropriate. Deputy Directors of Professional Services Review "85.(1) The Minister may appoint Panel members to be Deputy Directors of Professional Services Review. "(2) The maximum number of Deputy Directors is 15. "(3) Before appointing a medical practitioner to be a Deputy Director, the Minister must consult the AMA. The Minister must make an arrangement with the AMA under which the AMA consults other specified organisations and associations before advising the Minister on the appointment. "(4) Before appointing a practitioner other than a medical practitioner to be a Deputy Director, the Minister must consult such organisations and associations, representing the interests of the profession to which the practitioner belongs, as the Minister thinks appropriate. "Division 3-Referrals by the Health Insurance Commission
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Commission may refer matters to the Director "86.(1) The Commission may, in writing, refer to the Director the conduct of a person relating to one or both of the following: (a) whether the person has engaged in inappropriate practice in connection with rendering of services; (b) whether the person has engaged in inappropriate practice in connection with initiation of services. "(2) So far as the referred services concern rendering of services, the services must have been rendered: (a) during the 2 year period preceding the referral; and (b) on or after 1 September 1993; whether or not any or all of the services were initiated before the start of that period and/or before that day. "(3) So far as the referred services concern initiation of services, the services must have been initiated: (a) during the 2 year period preceding the referral; and (b) on or after 1 September 1993. "(4) If the services were rendered or initiated before 1 July 1994, they must not include services in relation to which a matter had been referred, before that day, to: (a) a Medical Services Committee of Inquiry under Division 3 of Part V of this Act (as in force on the day on which the matter was so referred); or (b) an Optometrical Services Committee of Inquiry under Division 3A of Part V of this Act (as so in force); or (c) a Medical Services Federal Committee of Inquiry (Pharmaceutical Benefits) or a Medical Services Committee of Inquiry (Pharmaceutical Benefits) for a State under Division 2 of Part VIII of the National Health Act 1953 (as so in force); or (d) a Dental Services Federal Committee of Inquiry or a Dental Services Committee of Inquiry for a State under Division 2AA of Part VIII of the National Health Act 1953 (as so in force). Content and form of referrals "87.(1) The referral must specify whether it relates to one or both of the following: (a) specified services; (b) services rendered or initiated by a practitioner that are one or more of the following: (i) services of a specified class;