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HEALTH INSURANCE ACT 1973 - SECT 95 Constitution of Committees

HEALTH INSURANCE ACT 1973 - SECT 95

Constitution of Committees

  (1)   A Committee set up under section   93 in connection with a referral consists of the following members appointed by the Director:

  (a)   a Chairperson who is a Deputy Director; and

  (b)   2 other Panel members; and

  (c)   if subsection   (6) applies--not more than 2 additional Panel members.

  (1A)   If the person under review is not the practitioner who rendered or initiated all of the referred services, the Panel members referred to in paragraph   (1)(b) must be members of professions or specialties relevant to the field or fields of practice of the practitioner or practitioners who rendered or initiated the referred services.

  (2)   If the person under review is the practitioner who rendered or initiated all of the referred services, the Chairperson, and the other Panel members referred to in paragraph   (1)(b), must be practitioners who belong to the profession in which the practitioner was practising when the services were rendered or initiated.

  (3)   Subject to subsection   (4), the other Panel members referred to in paragraph   (1)(b) must also be:

  (a)   if the practitioner rendered or initiated the referred services as a consultant physician in a particular specialty--consultant physicians in relation to that specialty; or

  (b)   if the practitioner rendered or initiated the referred services as a specialist (other than a consultant physician) in a particular specialty--specialists in relation to that specialty; or

  (c)   if the practitioner rendered or initiated the referred services as a general practitioner--general practitioners.

  (4)   If the practitioner rendered or initiated the referred services as more than one kind of medical practitioner mentioned in subsection   (3), then:

  (a)   each other Panel member referred to in paragraph   (1)(b) must be a medical practitioner of at least one of those kinds; and

  (b)   those members must, in combination with each other, be medical practitioners of each of those kinds.

Example 1:   A practitioner renders referred services as a consultant physician in 2 different specialties. Subsection   (4) is satisfied if:

(a)   one other Panel member is a consultant physician in the first specialty and one other Panel member is a consultant physician in the second specialty; or

(b)   both other Panel members are consultant physicians in both specialties.

Example 2:   A practitioner renders referred services as a consultant physician in a particular specialty and as a general practitioner. Subsection   (4) is satisfied if:

(a)   one other Panel member is a consultant physician in that specialty and one other Panel member is a general practitioner; or

(b)   both other Panel members are consultant physicians in that specialty and general practitioners.

  (6)   The Director may appoint an additional Panel member or additional Panel members referred to in paragraph   (1)(c) if the Director thinks it is desirable to do so in order to give the Committee a wider range of clinical expertise, having regard to the services specified in the referral.

  (7)   An additional Panel member must be a member of a profession or a specialty relevant to a field of practice of the practitioner, or any of the practitioners, who rendered or initiated the referred services.

  (8)   Any Panel member whom the Director consulted under section   90 in relation to the referral must not be appointed as a member of the Committee.

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